Persistent dysphagia after laparoscopic vagotomy

Background: Laparoscopic vagotomy represents a new and less invasive treatm ent for peptic ulcer disease, but the problem of postvagotomy dysphagia has not been solved. The aim of this study was to determine the etiologic fact ors related to long-term laparoscopic postvagotomy dysphagia. Methods: Two female and 11 male patients with a mean age of 48.5 years who underwent laparoscopic vagotomy were investigated retrospectively. Preopera tive diagnosis included duodenal ulcer resistant to medical treatment, gast ric hypersecretion, gastric outlet obstruction, cholelithiasis, and gastroe sophageal reflux disease (GERD). Ten patients underwent laparoscopic highly selective vagotomy, and three patients had laparoscopic truncal vagotomy w ith gastrojejunostomy or pyloroplasty. Nine of these patients had a Nissen fundoplication in conjunction with the vagotomy. Results: The median long-term follow-up period was 47 months. Two patients complained of severe dysphagia, one of moderate dysphagia, and two of mild dysphagia. Neither type of vagotomy nor an additional fundoplication was co rrelated with the severity of postoperative long-term dysphagia. Severity o f postoperative dysphagia was associated with severity of preoperative dysp hagia (r = 0.752, p = 0.003) but not with heartburn (r = 0.358, p = 0.531) or regurgitation (r = 0.024, p = 0.938). The cause of preoperative dysphagi a varied; however, all of these patients had GERD and consequent esophageal lesions. Conclusion: Preexisting dysphagia appears to play an integral role in persi stent postoperative dysphagia. Care must be taken to construct a loose fund oplication in patients with dysphagia.