Abstracts
2000 Digestive Disease Week

# 2254 Complete Fundoplication Is NOT Associated with Increased Dysphagia in Patients with Abnormal Esophageal Motility.
T. Ryan Heider, Timothy M. Farrell, S. Amanda Kircher, Mark J. Koruda, Craig Colliver, Kevin E. Behrns, Chapel Hill, NC

BACKGROUND: Some authors consider abnormal esophageal motility a contraindication to complete (360-degree) fundoplication because of a purported risk of postoperative dysphagia. However, partial fundoplication is associated with increased postoperative esophageal acid exposure. AIM: To determine if complete fundoplication is associated with increased postoperative dysphagia in patients with abnormal esophageal motor function. METHODS: The medical records of 140 consecutive patients with gastroesophageal reflux disease (GERD) who underwent attempted laparoscopic fundoplication (79 females; mean age 48 yrs) were reviewed retrospectively to document demographic data, symptoms, indications and diagnostic test results. Of the 140 antireflux procedures, 125 were completed laparoscopically. Overall, 126 patients underwent complete fundoplication. Of these, 25 met manometric criteria for abnormal esophageal motility (£30mmHg mean distal esophageal body pressure or £80% peristalsis), and 68 were normal. Thirty-three patients had incomplete manometric data, and were therefore excluded from the final analysis. A previously validated GERD-specific symptom survey was mailed to all patients. Non-responders received follow-up by telephone. Patients were asked to report heartburn, difficulty swallowing and overall satisfaction using a 0 (“none”) to 5 (“incapacitating”) scale. Survey responses were obtained in 71% of patients. Sixtyfive patients who underwent complete fundoplication and had manometric data available responded (46 normal manometry; 19 abnormal manometry). Median follow-up was 2 years (range 6 months to 5 years). Outcomes were compared using the Mann-Whitney U test (ordinal, unmatched data). RESULTS: After complete fundoplication, no significant differences in postoperative heartburn, difficulty swallowing or overall satisfaction were noted between patients with normal and abnormal esophageal motility. Similarly, no differences in outcomes were detected after partial fundoplication. CONCLUSION: Clinical outcomes after complete fundoplication do not differ markedly between patients with normal and abnormal esophageal motility. A randomized trial comparing complete and partial fundoplication is warranted since complete fundoplication does not impact postoperative swallowing in patients with abnormal motility in this retrospective cohort.