Postoperative Dysphagia Does Not Predict Higher Long-Term Failure Rates for Laparoscopic Antireflux Surgery

Konstantinos I Makris, MD, Maria A Cassera, BS, Andrew S Kastenmeier, MD, Christy M Dunst, MD, Lee L Swanström, MD. Legacy Health

Introduction: Dysphagia is a fairly common postoperative symptom after laparoscopic anti-reflux surgery, usually attributed to postoperative edema or a “too tight” fundoplication. It is associated with discomfort, the occasional need for endoscopic dilation and rarely revisionary surgery. It has not been described whether postoperative dysphagia is associated with poorer outcomes of fundoplication in terms of long-term reflux control.

Methods: We hypothesized that the presence of dysphagia in the immediate postoperative period has no association with long-term failure of the anti-reflux procedure and recurrence of GERD symptoms. A retrospective review of a prospectively maintained database of patients undergoing anti-reflux surgery was performed. The study population included patients, who underwent primary laparoscopic Nissen fundoplication between the years 1991 and 2010. The presence of dysphagia on their first postoperative visit (<30 days) was used to divide them in the dysphagia (D) and the non-dysphagia (ND) group. The recurrence of heartburn or regurgitation, as well as the pH studies on long-term follow-up (approximately 6 months, which is commonly accepted as the gold standard for long-term success) were compared between the two groups. A validated grading system (range 0-4) was used to measure the intensity/frequency of symptoms.

Results: 1223 patients underwent primary laparoscopic Nissen fundoplications during the study period and met the inclusion criteria. Both short and long-term follow-up was available in 821 patients, of which 331 were male and 490 female. The mean age was 54.2 and BMI 29.8. 423 patients experienced postoperative dysphagia whereas 398 patients did not. The mean regurgitation score of the D group on the long-term follow-up was 0.25 compared to 0.19 for the ND group (p=0.213). The heartburn score was 0.37 for the D group compared to 0.32 for the ND group (p=0.379). Of the 821 patients, 599 underwent routine postoperative pH testing. The mean DeMeester score in the D group (n=308) was 11.7 compared to 13.2 for the ND group (n=291; p=0.541).

Conclusions: Postoperative dysphagia, even if it requires intervention, is not associated with worse long-term GERD symptom control after primary laparoscopic anti-reflux surgery.