Laparoscopic antireflux surgery

Background: Concern has been raised about operating on patients with gastroesophageal reflux disease (GERD) and normal lower esophageal sphincter (LES) pressure for the fear that a fundoplication may fail to control reflux and result in a high rate of postoperative dysphagia. We hypothesized that fundoplication is effective in patients with GERD irrespective of the preoperative LES pressure, and that in patients with normal LES pressure, a total fundoplication does not result in a high incidence of dysphagia. Methods: We studied 280 unselected patients with GERD who underwent laparoscopic fundoplication. They were divided in three groups based on the preoperative LES pressure (normal, 14–24 mmHg): group A (LES pressure, 0–6 mmHg; 61 patients; 22%); group B (LES pressure, 7–13 mmHg; 178 patients; 64%); group C (LES pressure, ?14 mmHg; 41 patients; 14%). De novo dysphagia was defined as new onset of postoperative dysphagia lasting more than 10 weeks. The average follow-up period was 17 ± 22 months. Results: There was no difference in resolution of symptoms among the three groups. Heartburn and regurgitation resolved or improved respectively in 96% of group A, 90% of group B, and 91% of group C patients. In addition, there was no difference in the incidence of de novo dysphagia, which occurred in 8% of group A, 7% of group B, and 2% of group C. Conclusions: We conclude that fundoplication controlled GERD irrespective of preoperative LES pressure, and that a normal LES pressure before surgery was not associated with a higher rate of postoperative dysphagia.