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Surgical Management of Gastroesophageal Reflux Disease in Patients with Severe Esophageal Dysmotility

  • Priscila R. Armijo
  • Dietric Hennings
  • Melissa Leon
  • Akshay Pratap
  • Austin Wheeler
  • Dmitry Oleynikov
2018 SSAT Plenary Presentation

Abstract

Background

Gastroesophageal reflux disease (GERD) and esophageal dysmotility are often disqualifying criteria for fundoplication due to dysphagia complications. A tailored partial fundoplication may improve GERD in patients with severe esophageal motility disorders. We evaluate this approach on GERD improvement in non-achalasia esophageal dysmotility patients.

Methods

A single-institution prospective database was reviewed (2007–2016), with inclusion criteria of GERD, previous diagnosis of non-achalasia esophageal motility disorder, and laparoscopic partial fundoplication. Diagnosis of previous achalasia diagnosis or diffused esophageal spasm was excluded. Motility studies, pre- and post-upper gastrointestinal imaging (UGI), esophageal symptom scores, antacid, and PPI use were collected pre-op, 6 months, 12 months, and long-term (LT). Statistical analysis was made using SPSS v.23.0.0, α = 0.05.

Results

Fifty-two patients met the inclusion criteria. A total of 17.3% had esophageal body amotility, 79.6% had severe esophageal dysmotility. A total of 65.9% women (mean age 64 ± 15.7), mean peristalsis 45.3 ± 32.6%, and failed peristalsis 36.0 ± 32.2%. Mean LES residual pressure was 15.0 ± 18.0 mmHg, and 40.7% had hypotensive LES. Mean follow-up time was 25 months [1–7 years], with significant improvement in symptoms and reduction in PPI and antacid use at all time-points compared to pre-op. A total of 74% had UGI studies at 12 months; all showed persistent dysmotility. Six patients had radiographic hiatal hernia recurrence, with only one being clinically symptomatic postoperatively. Three required dilation for persistent dysphagia.

Conclusions

A tailored partial fundoplication may be effective in symptom relief for non-achalasia patients with esophageal motility disorders and GERD. Significant symptom improvement, low HHR, and PPI use clearly indicate this approach to be effective for this population.

Keywords

Esophageal dysmotility GERD Anti-reflux surgery Laparoscopic partial fundoplication 

Notes

Author’s Contribution

The contribution of each author, as defined by the ICMJE guidelines, is as follows: PRA: data acquisition, analysis, and interpretation; drafting and revision; final approval; accuracy and integrity; DH: data acquisition, analysis, and interpretation; drafting; final approval; accuracy and integrity; ML: data acquisition, analysis, and interpretation; revision; final approval; accuracy and integrity; AP: data acquisition, analysis, and interpretation; drafting; final approval; accuracy and integrity; AW: data acquisition, analysis, and interpretation; drafting; final approval; accuracy and integrity; DO: design of work, data acquisition, analysis, and interpretation; revision; final approval; accuracy and integrity.

Funding

Funding for this study was provided by the Center for Advanced Surgical Technology at the University of Nebraska Medical Center.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Center for Advanced Surgical TechnologyUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Department of SurgeryUniversity of Nebraska Medical CenterOmahaUSA
  3. 3.College of MedicineUniversity of Nebraska Medical CenterOmahaUSA

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