ESOPHAGEAL DYSMOTILITY IS NOT ASSOCIATED WITH POOR OUTCOME AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION

Background Nissen fundoplication has became the standard operation in the surgical management of gastro-oesophageal reflux disease. Postoper ative dysphagia is thought to occur more commonly in patients with oes ophageal dysmotility and it has been recommended that fundoplication b e modified or avoided in these patients. The aim of this study was to determine the outcome of patients with normal motility and dysmotility undergoing laparoscopic Nissen fundoplication. Methods This was a sin gle-centre prospective cohort study with 1-year follow-up, using dysph agia as the main outcome variable. Of 81 patients who underwent laparo scopic surgery, 48 had normal motility and 33 had oesophageal dysmotil ity (defined as percentage peristalsis, using ten wet swallows, of 50 per cent or less and/or a mean distal pressure of less than 40 mmHg). Results Dysphagia was present before operation in 14 of 48 patients wi th normal motility and 15 of 33 in the dysmotility group (P = 0.2). At 3-month follow-up, new or worse dysphagia was present in 13 of 48 pat ients in the normal group and four of 33 in the dysmotility group (P = 0.17). At 1 year the incidence of dysphagia was six of 48 in the norm al group and five of 33 in the dysmotility group (P = 0.9). Conclusion Preoperative manometric assessment of oesophageal motility does not c orrelate with postoperative outcome, and oesophageal dysmotility shoul d not be regarded as a contraindication to laparoscopic Nissen fundopl ication.