Abstracts
1999 Digestive Disease Week

# 2111 LAPAROSCOPIC ANTIREFLUX SURGERY AND TREATMENT OF PEPTIC ESOPHAGEAL STRICTURES
Christina G Richards, Univ of Washington, Seattle, WA; T Eubanks, S Horgan, D Pohl, C Pellegrini

To examine the role of operative management of esophageal strictures and gastroesophageal reflux disease (GERD), data base analaysis was used to identify twenty-seven patients treated between 1993 and 1998. A stricture was defined as present in patients with dysphagia and clear radiographic evidence of stricture or, endoscopic diagnosis with dilation and subsequent relief of dysphagia. Patients underwent treatment with medication and dilation, or operation. Direct patient contact was used to assess symptom scores, subsequent procedures performed (operations or dilations), and patient satisfaction. Four patients (15%) had abnormal esophageal motility. All patients had gastoesphageal reflux with an average Demeester score of 73 (range 4-246). Six patients (22%) were treated medically and 21 operatively. Nissen fundoplication was performed in all cases, with a Collis gastroplasty required for one patient. All cases were completed laparoscopically without compliction. Twenty patients (82%) treated operatively rated their results as excellent. Dysphagia was eliminated in all but one patient. Two patients had recurrent reflux and rated their results as fair or poor. None of the patients required esophageal resection or subsequent antireflux procedure. The average number of pre-operative dilations was 2.8; the average number of post-operative dilations was 0.33. In the group treated medically 33% of patients reported excellent or good results from therapy. A mean of nine dilations was required throughout their treatment. Laparoscopic Nissen fundoplication is effective in the treatment of peptic esophageal strictures. Excellent overall clinical results may be expected in over 80% of patients with resolution of dysphagia in up to 95%. The need for post treatment dilation is significantly reduced after an antireflux procedure. Early correction of reflux by minimally invasive techniques may obviate the need for repeat dilations and esophagectomy in most patients with peptic strictures.

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