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2007 Program and Abstracts | 2007 Posters
Does a Peptic Esophageal Stricture Requiring Preoperative Dilation Impact Outcome After Laparoscopic Nissen Fundoplication?
Sarah M. Cowgill*, Emily Kraemer, Rachel Gillman, Desiree Villadolid, Alexander S. Rosemurgy
Surgery, University of South Florida, Tampa, FL

Introduction: Peptic esophageal strictures reflect advanced gastroesophageal reflux disease (GERD) and are thought to negatively impact outcome after laparoscopic Nissen fundoplication (LNF). This study was undertaken to evaluate outcome after LNF for patients with strictures that required preoperative dilation.
Methods: 113 patients, 58% male, of median age 58 years and DeMeester scores of 40, 57±54.5, underwent dilations for peptic esophageal strictures prior to fundoplication. They were compared to 113 concurrent patients, 48% male, of median age 53 years and DeMeester scores of 44, 62±65.9 without peptic strictures who underwent LNF. Median follow-up was 2.5 years. Before and after fundoplication, among many symptoms, patients scored the frequency and severity of dysphagia, chest pain, vomiting, regurgitation, choking, and heartburn using a Likert scale (0=never/not bothersome to 10=always/very bothersome). Data are presented as median, mean±SD.
Results: Prior to LNF, of all symptoms, only dysphagia was more frequent or severe in patients with strictures (Table). LNF reduced the frequency/severity of all symptoms for patients with or without preoperative strictures (Table). After LNF, the frequency and severity of all symptoms were similar between patients with vs. without preoperative strictures (Table). For patients with strictures undergoing dilation vs. patients without strictures, 78% vs. 81% felt their symptoms were greatly improved after LNF, 78% vs. 79% felt their outcome was satisfying, and 81% vs. 84% felt they would undergo LNF again knowing then what they know now.
Conclusions: For patients with peptic strictures who required preoperative dilation, LNF relieves symptoms dramatically with outcomes similar to patients undergoing LNF without preoperative strictures. A peptic stricture adequately dilated preoperatively does not impact outcome after LNF.

Patients with Strictures Patients without Strictures
Frequency Severity Frequency Severity
Dysphagia Preop 6, 5 ± 3.4 # 5, 5 ± 3.7 # 2, 4 ± 3.6 1, 3 ± 3.5
Postop 2, 3 ± 3.4 * 1, 2 ± 2.8 * 2, 3 ± 3.2 0, 2 ± 2.7 *
Chest Pain Preop 6, 5 ± 3.7 3, 4 ± 3.8 6, 5 ± 3.8 1, 3 ± 3.8
Postop 2, 3 ± 3.3 * 0, 2 ± 2.7 * 2, 3 ± 2.8 * 0, 1 ± 2.3 *
Regurgitation Preop 6, 6 ± 3.3 6, 5 ± 3.8 6, 5 ± 3.8 6, 5 ± 3.8
Postop 2, 2 ± 2.6 * 0, 1 ± 1.9 * 0, 1 ± 2.1 * 0, 1 ± 3.1 *
Heartburn Preop 8, 7 ± 3.2 8, 7 ± 3.7 8, 7 ± 3.6 8, 7 ± 3.7
Postop 1, 2 ± 2.8 * 0, 2 ± 2.6 * 0, 2 ± 2.3 * 0, 1 ± 2.2 *
Choking Preop 4, 4 ± 3.4 5, 5 ± 3.8 2, 4 ± 3.8 4, 4 ± 3.9
Postop 1, 2 ± 2.9 * 1, 2 ± 2.8 * 0, 2 ± 2.6 * 1, 2 ± 3.1 *

* Less than before LNF, p < 0.05, Wilcoxon matched pairs test. # Greater than patients without strictures, p < 0.02, Mann Whitney U-test.


2007 Program and Abstracts | 2007 Posters
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