Abstracts
1999 Digestive Disease Week

# 2102 THE EFFECT OF AN ESOPHAGEAL BOUGIE ON LONG-TERM DYSPHAGIA RATES FOLLOWING NISSEN FUNDOPLICATION: A DOUBLE-BLIND, PROSPECTIVE, RANDOMIZED TRIAL
E Patterson, Legacy Portland Hosp, Portland, OR; Lee Swanstrom, Legacy Minimally Invasive Surg, Portland, OR; Paul Hansen, Daniel Herron, Legacy Hosp System, Portland, OR; N Ramzi, B Standage, Legacy Portland Hosp, Portland, OR

Based on historical, uncontrolled studies, it is generally believed that Nissen fundoplication should be performed over an esophageal bougie to minimize postoperative dysphagia. However, serious bougie-related complications such as esophageal or gastric perforation have been documented. Our objective was to determine whether the use of a bougie reduces the incidence of postoperative dysphagia following laparoscopic Nissen fundoplication. 171 consecutive patients undergoing standard laparoscopic Nissen fundoplication between March 1st, 1996, and July 31st, 1998 were randomized to undergo fundoplication with a bougie (n=81) or without a bougie (n=90). In the bougie group a 56 French bougie was advanced through the distal esophagus after mobilization of the esophagus, prior to construction of the wrap. Severity and frequency of dysphagia were assessed in a blinded fashion, using a standardized scoring system. The mean operating time was 148 minutes (range 65 - 295). The operative morbidity was 9% in the bougie group and 11 % in the no bougie group. One mucosal laceration of the distal esophagus occurred in the bougie group, but there were no full-thickness esophageal perforations. The 30-day mortality was zero. Long-term dysphagia assessment was completed in 90% of patients, at a mean of follow-up of 11 months (range 3 - 33). Postoperative dysphagia was present in 13 (18%) patients in the bougie group and 24 (30%) patients in the no bougie group. Severe dysphagia was found in 11 (7%) patients, 3 (4%) in the bougie group, and 8 (10%) in the no bougie group. By Chi-square analysis, the incidence of long-term postoperative dysphagia was significantly reduced by the use of a bougie (p = 0.004). Placement of an esophageal bougie is therefore an important technical element of laparoscopic Nissen fundoplication, since it significantly reduces the incidence of long-term dysphagia.

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