PROSPECTIVE EVALUATION OF DYSPHAGIA BEFORE AND AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION WITHOUT ROUTINE DIVISION OF SHORT GASTRICS

The incidence and severity of dysphagia before and 6 months after lapa roscopic Nissen fundoplication without routine division of short gastr ic vessels are presented. Laparoscopic Nissen fundoplication was under taken in 195 patients over 32 months with 116 patients who had prospec tive follow-up longer than 6 months. Patients underwent a 24-h pH reco rding, esophageal manometry, and symptom score assessment before and 6 months after surgery. There was a significant (p < 0.0001) improvemen t in the percent of reflux in 24-h (8.61 +/- 0.74 to 0.68 +/- 0.12), l ower esophageal pressure (8.53 +/- 0.51 to 23.11 +/- 1.1 mm Hg), and r eflux symptom scores (40.97 +/- 1.13 to 12.11 +/- 1.1) at 6 months. A similar improvement (p < 0.0001) was also observed in the dysphagia sy mptom score (4.58 +/- 0.38 to 1.96 +/- 0.32), with more than half the patients reporting improvement after surgery. No correlation was obser ved between the change in dysphagia score and the postoperative lower esophageal pressure or esophageal motor function. These data suggest t hat the incidence of clinically significant dysphagia after laparoscop ic Nissen fundoplication, even without division of short gastric vesse ls, is low. Improvement in the dysphagia score after surgery is intere sting and warrants further investigation.