ESOPHAGEAL AND LOWER ESOPHAGEAL SPHINCTER PRESSURE PROFILES 6 AND 24 MONTHS AFTER LAPAROSCOPIC FUNDOPLICATION AND THEIR ASSOCIATION WITH POSTOPERATIVE DYSPHAGIA

Background: It has been suggested that antireflux surgery may cause an improvement in esophageal motor function (EMF) and lead to reduced po stoperative dysphagia. Methods: We evaluated the changes in dysphagia symptom scores and esophageal and lower esophageal sphincter (LES) pre ssures in patients before (n = 381), at 6 months (n = 260), and at 24 months (n = 97) after laparoscopic fundoplication. Results: There was a significant increase in LES basal and nadir pressure following surge ry in all patients and an improvement in EMF only in patients with poo r preoperative esophageal motor function. A total of 76% of the patien ts reported no dysphagia or an improved dysphagia score 6 and 24 month s after surgery. This improvement was more marked in patients with poo r EMF. An improvement in EMF did not correlate with the improvement in dysphagia score reported by other patients. Patients with increased d ysphagia scores 2 years after surgery had significantly higher LES bas al and nadir pressures as compared to other patients. Conclusions: Lap aroscopic Nissen fundoplication is associated with an overall reductio n in dysphagia scores and leads to an improvement in esophageal motor function in patients with poor preoperative esophageal motility. Tight ness and inadequate relaxation of the wrap during swallowing may be a determinant of long-term dysphagia.