Introduction:A known potential complication of antireflux surgery is prolonged (>12 weeks) postoperative dysphagia. The aim of this study was to evaluate the impact of specific technical operative details on the incidence and severity of prolonged post operative dysphagia.
Methods and materials: Data was obtained from 424 patients participating in the National Registry for Antireflux Surgery and Barrett's Esophagus, a prospectively collected database of patients undergoing Anti Reflux Surgery (ARS) for reflux disease. Preoperative symptoms were collected and details of the operation that were recorded including the surgical approach, type of procedure, wrap length, use of a bougie, crural closure and suture material used, number and technique of crural closure stitches, whether the short gastric vessels were divided, use of pledget, length of the operation, and whether this was the first operation or a reoperation. Follow up was at 6 month intervals using a detailed questionnaire asking specifically about dysphagia. Responses indicating either “significant daily problems that interfere with the ability to lead a normal life” or “troublesome but not enough to impair the ability to lead a normal life” were considered to represent significant dysphagia.
Results:From the 424 patients we excluded 200 patients that had preoperative dysphagia. This left 224 patients, 60% males and 40% females with a mean age of 53 years. Median follow up was 3.3 years. Prolonged significant dysphagia developed in 28 (12.5%) patients after ARS. Compared to the patients that had a bougie used during the operation, those patients that had a fundoplication without a bougie had a significantly higher incidence of prolonged dysphagia (10.2% vs. 28.6%, p=0.008). A redo antireflux operation was associated with a trend toward more dysphagia. In contrast, the technique of crural closure including use of pledgets did not affect the risk of dysphagia.
Conclusion:Data from multiple centers demonstrate that prolonged dysphagia was significantly less likely to occur when a bougie was used during the performance of an antireflux operation. Consequently, a bougie should routinely be used during Nissen fundoplication.