PERSISTENT DYSPHAGIA FOLLOWING LUNG TRANSPLANT AND ANTI-REFLUX SURGERY
Michael P. Rogers*, Eric Solomon, Nolan Reinhart, Kapil Patel, Christopher Ducoin, Vic Velanovich
Surgery, USF Health Morsani College of Medicine, Tampa, FL
Purpose
Persistent post-operative dysphagia is a significant burden. At a high-volume center, patients having undergone lung transplantation and anti-reflux procedures appear to report an increased incidence of post-operative dysphagia as compared to their non-transplant cohort. We sought to better characterize this patient population.
Methods
A single institution retrospective review of patients with history of lung transplant and subsequent anti-reflux surgery was undertaken. Patient demographics, pre-operative pulmonary function tests, and results from esophageal manometry, pH impedance, esophagogastroduodenoscopy, esophagram, and post-operative dysphagia symptoms, work-up testing, and necessary interventions were reviewed.
Results
A total of 45 patients were included for review. The majority of patients were male, mean age 58.3 years, who primarily underwent lung transplantation for emphysema-related advanced COPD (31.1%) and anti-reflux with Nissen fundoplication (64.4%). Twenty-nine patients (64.4%) reported some degree of persistent dysphagia requiring further evaluation and treatment with medical or surgical intervention, though significant heterogeneity existed among imaging and treatment modalities. Management ranged from daily medication to re-operative anti-reflux surgery. Eight (17.8%) patients required esophageal dilation (mean 1.75 dilations, range 1-5), five (11.1%) required revision surgical intervention.
Conclusion
The incidence of persistent dysphagia following lung transplantation and anti-reflux surgery has yet to be fully characterized. We report a high incidence of persistent dysphagia in these patients with disparate treatment strategies. Further investigation into this cohort is warranted to further elucidate these findings.
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