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World Journal of Surgery

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01-04-2019 | Original Scientific Report

Preoperative High-Resolution Manometry Criteria are Associated with Dysphagia After Nissen Fundoplication

Authors: Steve R. Siegal, Christy M. Dunst, Ben Robinson, Elizabeth N. Dewey, Lee L. Swanstrom, Steven R. DeMeester

Published in: World Journal of Surgery | Issue 4/2019

Abstract

Background

Dysphagia after Nissen fundoplication is challenging for patients. High-resolution manometry (HRM) has rarely been studied preoperatively to determine whether manometry values correlated with postoperative dysphagia after fundoplication. We aim to determine whether HRM criteria could predict dysphagia after Nissen fundoplication.

Methods

A retrospective review of single-institution laparoscopic Nissen fundoplications (LNF) from 2013 to 2015 was completed. Dysphagia was graded using a standard scale. Four groups were: those with new postoperative dysphagia (ND), never had dysphagia (NV), continued dysphagia (CD), and resolved dysphagia (RD). Manometry criteria included distal contractile integral (DCI), contraction front velocity (CFV), distal latency (DL), integrated relaxation pressure (IRP), percent peristalsis (PP), and distal esophageal contraction amplitude (DECA). Statistical bootstrapping was used to power sample sizes for ANOVA analysis.

Results

Ninety-four patients were included in the original cohort. Statistical bootstrapping sample size was 2992 patients. Among patients who did not have dysphagia prior to LNF, no HRM metric was associated with developing new dysphagia. Among those with dysphagia prior to LNF, a higher DCI, CFV, DL, PP, and DECA were associated with resolution of dysphagia. The RD group was 2.77 times more likely to have a DCI ≥ 1000 mmHg-s-cm compared with the CD group.

Conclusions

HRM criteria could not predict the development of postoperative dysphagia. However, in those with preoperative dysphagia and strong manometry criteria, dysphagia is more likely to resolve after Nissen fundoplication. Meanwhile, in those with preoperative dysphagia and weak manometry, dysphagia may persist and these patients may be better served with a partial fundoplication.

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Title: Preoperative High-Resolution Manometry Criteria are Associated with Dysphagia After Nissen Fundoplication
Authors: Steve R. Siegal
Christy M. Dunst
Ben Robinson
Elizabeth N. Dewey
Lee L. Swanstrom
Steven R. DeMeester
Publication date: 01-04-2019
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 4/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4870-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative High-Resolution Manometry Criteria are Associated with Dysphagia After Nissen Fundoplication

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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