THE EFFECT OF SYMPTOMS AND NONSPECIFIC MOTILITY ABNORMALITIES ON OUTCOMES OF SURGICAL THERAPY FOR GASTROESOPHAGEAL REFLUX DISEASE

The outcome of Nissen fundoplication in patients with a nonspecific mo tility abnormality compared with the outcome in patients with normal m otility is unknown. One hundred consecutive patients who underwent pri mary Nissen fundoplication were evaluated before and a median of 50 mo nths after operation, with emphasis on the presence of a preoperative motility disorder and its relationship to preoperative and postoperati ve symptoms. Compared with patients who had normal motility, patients with a nonspecific motility abnormality had a greater prevalence and s everity of heartburn and regurgitation before operation. These patient s also had a greater esophageal exposure to gash ic juice on pH monito ring as a result of poorer esophageal clearance function. The prevalen ce and severity of preoperative dysphagia was not related to the prese nce of a motility disorder. A 90% or a 95% actuarial success rate was achieved in the relief of heartburn and regurgitation over a 96-month period in patients with and without a motility abnormality. The overal l actuarial success rate was 93%. Dysphagia was rarely caused or made more severe by the procedure; if present before the operation, it was relieved in most patients. The prevalence of persistent postoperative dysphagia was similar in patients with and without a motility abnormal ity. The success of Nissen fundoplication in properly selected patient s is not affected by the presence of a nonspecific motility disorder.