Laparoscopic Fundoplication in Patients with a Hypertensive Lower Esophageal Sphincter
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A small proportion of patients evaluated with manometry prior to a fundoplication have a high-pressure lower esophageal sphincter (LES). This paper examines the outcome of laparoscopic fundoplication for these patients.
Material and Methods
Between October 1991 and December 2006, 1,886 patients underwent primary laparoscopic fundoplication. Those with a high-pressure LES on preoperative manometry (LESP ≥30 mm Hg at end expiration) were identified from a prospective database. Long-term outcomes were determined using analogue symptom scores (0–10) for heartburn, dysphagia, and patient satisfaction and compared to those of a matched control group.
Thirty patients (1.6%), nine men and 21 women, median age 51 years, had a hypertensive LES (mean, 36 mmHg; range, 30–55). Median follow-up after fundoplication was 99 (12–182) months. These patients had similar mean symptom scores to 30 matched controls for heartburn (2.3 vs. 2.2, P = 0.541), dysphagia (2.7 vs. 3.1, P = 0.539), and satisfaction (7.4 vs. 7.6, P = 0.546). Five patients required revision for dysphagia compared to no control patients (P = 0.005). These patients had a higher preoperative dysphagia score (6.6 vs. 3.1, P = 0.036).
Laparoscopic fundoplication can be performed with good long-term results for patients with reflux and a hypertensive LES. However, those with preoperative dysphagia have a higher failure rate.
KeywordsLower esophageal sphincter Antireflux surgery Gastroesophageal reflux
The authors would like to acknowledge the invaluable assistance of Carolyn Lally, Janet Pinno, Lorelle Smith, and Nicky Ascott in obtaining follow-up data and maintaining the laparoscopic fundoplication database. We would also like to thank surgeons Peter G. Devitt and Philip A. Game from the Royal Adelaide Hospital and David I Watson and Justin Bessell from Flinders Medical Centre, Adelaide, for contributing patients to the database.
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