Background: Dysphagia is experienced by many patients after antireflux surg
ery. This literature review examines factors associated with the developmen
t, prediction and management of postoperative dysphagia,
Methods: Published studies examining issues related to dysphagia, gastro-oe
sophageal reflux and fundoplication were reviewed.
Results: Postoperative dysphagia is usually temporary but proves troublesom
e for 5-10 per cent of patients. Technical modifications, such as a partial
wrap, division of short gastric vessels and method of hiatal closure, have
not conclusively reduced its incidence. There is no reliable preoperative
test to predict dysphagia,
Conclusion: It is uncertain whether postoperative dysphagia arises from pat
ient predilection or is largely a consequence of mechanical changes created
by fundoplication. Anatomical errors account for a significant proportion
of patients referred for correction of dysphagia but these are uncommon in
large single-institution studies. Abnormal manometry cannot predict dysphag
ia and, on current evidence, 'tailoring' the operation does not prevent its
occurrence.