Abstracts
1997 Digestive Disease Week

Laparoscopic fundoplication for peptic esophageal strictures and dysphagia.

H Spivak, T Trus, JP Waring, GD Branum, JG Hunter. Emory University School of Medicine, Atlanta, GA .

Laparoscopic fundoplication (LF) is an excellent treatment for gastroesophageal reflux disease (GERD). The operative results for patients with pre-operative dysphagia associated with peptic esophageal stricture are less conclusive. Over a 5-year period, 458 patients underwent LF for GERD at our institution. Moderate to severe dysphagia associated with esophageal stricture was found in 40 patients (9%). The average age was 52 years (range 27-74). Prior to surgery, the patients were treated with omeprazole and/or H2 blockers for a prolonged period of time (median 5 yrs, range 0.8-30 yrs). Sixteen patients had severe and incapacitating dysphagia (score 4). Twenty-four patients had dysphagia that frequently (score 3, n=14) or occasionally (score 2, n=10) interfered with daily activity. At the preoperative period, nineteen patients required 1-2 dilatations, seven patients required 3-5 dilatations, and ten patients required multiple (>5) esophageal dilatations. Twenty seven patients underwent their last dilatation <4 months prior to surgery. All patients underwent preoperatively esophageal motility studies and no primary motility disorders were found. Thirty four Nissen, 4 Toupet, and 2 Collis Nissen fundoplications were performed. Average follow-up was 1.5 years (range 0.5 - 4 yrs). Symptom scores (±St.D) were:

Pre-op Score               Follow-up Score
                     Dysphagia      Heartburn     Dysphagia    Heartburn
 Pts.w/stricture
 & dysphagia          3.2±0.8        2.9±1.2       0.5±0.8      0.2±0.6
 All Patients*        1.3±1.4        2.7±1.3       0.4±0.7      0.4±0.8
         *previously published data

Only four patients have required esophageal dilatation after surgery. One of these patients required reoperation. We believe LF to be an effective therapy for patients with dysphagia and peptic esophageal stricture.