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Open Access 01-04-2019

Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication

Authors: Milena Nikolic, Katrin Schwameis, Georg Semmler, Reza Asari, Lorenz Semmler, Ariane Steindl, Berta O. Mosleh, Sebastian F. Schoppmann

Published in: Surgical Endoscopy | Issue 4/2019

Abstract

Background

Although around 30% of patients with gastroesophageal reflux disease (GERD) are insufficiently treated with medical therapy, only 1% opt for surgical therapy. One of the reasons behind this multifactorial phenomenon is the described adverse effect of long-term dysphagia or gastric bloating syndrome after surgical treatment. Aim of this study was to evaluate the most common side effects associated with anti-reflux surgery, as well as long-term outcomes in a large cohort of highly surgically standardized patients after laparoscopic Nissen fundoplication (LNF).

Methods

Out of a prospective patients’ database including all patients that underwent anti-reflux surgery between 01/2003 and 01/2017 at our institution, 350 consecutive patients after highly standardized LNF were included in this study. A standardized interview was performed by one physician assessing postoperative gastrointestinal symptoms, proton pump inhibitor intake (PPI), GERD-Health-Related-Quality-of-Life (GERD-HRQL), Alimentary Satisfaction (AS), and patients’ overall satisfaction.

Results

After a median follow-up of 4 years, persistent dysphagia (PD) after LNF was observed in 8 (2%) patients, while postoperative gas-bloat syndrome in 45 (12.7%) cases. Endoscopic dilatation was needed in 7 (2%) patients due to dysphagia, and 19 (5%) patients underwent revision surgery due to recurrence of GERD. The postoperative GERD-HRQL total score was significantly reduced (2 (IQR 0–4.3) vs. 19 (IQR 17–32); p < 0.000) and the median AS was 9/10. Heartburn relief was achieved in 83% of patients. Eighty-three percent of patients were free of PPI intake after follow-up, whereas 13% and 4% of the patients reported daily and irregular PPI use, respectively.

Conclusion

LNF is a safe and effective surgical procedure with low postoperative morbidity rates and efficient GERD-related symptom relief. PD does not represent a relevant clinical issue when LNF is performed in a surgical standardized way. These results should be the benchmark to which long-term outcomes of new surgical anti-reflux procedures are compared.

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Title: Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication
Authors: Milena Nikolic
Katrin Schwameis
Georg Semmler
Reza Asari
Lorenz Semmler
Ariane Steindl
Berta O. Mosleh
Sebastian F. Schoppmann
Publication date: 01-04-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6396-5

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Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication

Abstract

Background

Methods

Results

Conclusion

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Abstract

Background

Methods

Results

Conclusion

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