Results of laparoscopic antireflux surgery for dysphagia and gastroesophageal reflux disease

BACKGROUND: Little attention has been paid to nonobstructive dysphagia (dys phagia in the absence of an esophageal stricture) in patients with gastroes ophageal reflux disease (GERD). The objectives of this study were to assess (a) the incidence of nonobstructive dysphagia in patients with GERD; and ( b) the effects of laparoscopic fundoplication on nonobstructive dysphagia. METHODS: Esophageal manometry and pH monitoring identified 666 patients wit h GERD. Two hundred and eight patients (31%) without esophageal strictures complained of dysphagia in addition to heartburn and regurgitation. Forty-n ine (24%) of these patients underwent laparoscopic fundoplication. Esophage al function tests were repeated postoperatively in 12 patients (25%). Main outcome measures were effects of laparoscopic fundoplication on symptoms an d esophageal motor function. RESULTS: Dysphagia resolved postoperatively in 44 patients (90%), and impro ved in 2 patients (4%). Postoperative esophageal manometry showed a signifi cant increase in the length and pressure of the lower esophageal sphincter, without changes in its ability to relax in response to swallowing. CONCLUSIONS: About one third of GERD patients without strictures experience d dysphagia; and dysphagia resolved in about 90% of such patients following a laparoscopic fundoplication. Am J Surg. 1998;176:564-568. (C) 1998 by Ex cerpta Medica, Inc.