Factors predictive of dysphagia after laparoscopic Nissen fundoplication

Background: Persistent postoperative dysphagia occurs in up to 24% of patie nts who undergo a laparoscopic Nissen fundoplication for reflux disease [7] . We hypothesized that patient history, pH testing, and esophageal manometr y could be used to preoperatively identify patients at risk for this compli cation. Methods: Of 156 laparoscopic Nissen fundoplications performed over a 27-mon th period, we identified 19 patients (12%) who suffered from postoperative dysphagia longer than 3 months. The presenting complaint of preoperative sw allowing difficulty was noted as was the presence of a known esophageal str icture. Preoperative pH testing and esophageal manometry were performed for all subjects. We compared the following parameters to an age and gender-ma tched control group: history of esophageal stricture, presence of preoperat ive dysphagia, DeMeester reflux score, upper esophageal sphincter pressure and relaxation, esophageal body motility, location of respiratory inversion point, and lower esophageal sphincter length, resting pressure, and relaxa tion. Data were compared via t-test and Fisher's exact test. Results: Patients who presented before surgery with complaints of difficult y swallowing were more likely to suffer from postoperative dysphagia (p = 0 .029). Incidence of stricture, DeMeester score, and manometric measurements did not differ between the dysphagia and control groups (p > 0.05 for all parameters). Conclusions: Although preoperative studies are not helpful in identifying p atients at risk for persistent dysphagia after laparoscopic Nissen fundopli cation, patients presenting with the preoperative complaint of difficulty s wallowing are at increased risk for this complication.