TAILORED ANTIREFLUX SURGERY FOR GASTROESOPHAGEAL REFLUX DISEASE - EFFECTIVENESS AND RISK OF POSTOPERATIVE DYSPHAGIA

The Nissen fundoplication is not the proper antireflux procedure for p atients with poor esophageal peristalsis as it does not strengthen imp aired esophageal peristalsis. The aim of this study was to investigate if tailoring of antireflux surgery according to esophageal contractil ity is an effective treatment of gastroesophageal reflux disease (GERD ) with a low incidence of postoperative dysphagia. The Toupet fundopli cation was laparoscopically performed on 32 patients with poor esophag eal peristalsis and the Nissen fundoplication on 17 patients with norm al peristalsis. After a median follow-up of 15 months, only 1 of the 4 9 patients (2.04%) complained of heartburn. Acute esophagitis was foun d in none of them on endoscopy. Of 40 patients tested postoperatively, 2 (5%) underwent pathologic esophageal pH monitoring. Postoperative d ysphagia was found in two patients (4.1%) compared with 25 (51%) preop eratively (p < 0.05). There was a significant reduction of dysphagia f ollowing the Toupet fundoplication. Both procedures increased the rest ing pressure of the lower esophageal sphincter (LES) significantly, wh ich was more pronounced following the Nissen fundoplication. Relaxatio n of the LES was significantly better following the Toupet than after the Nissen fundoplication. There was significant improvement of esopha geal peristalsis following the Toupet fundoplication. Tailored antiref lux surgery is an effective strategy for treatment of GERD. The incide nce of postoperative dysphagia is low owing to improvement of impaired esophageal peristalsis following the Toupet fundoplication. It may be due to the fact that the Toupet fundoplication causes less esophageal outflow resistance than the Nissen fundoplication.