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Identification of risk factors for postoperative dysphagia after primary anti-reflux surgery

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Abstract

Background

Transient postoperative dysphagia is not uncommon after antireflux surgery and usually runs a self-limiting course. However, a subset of patients report long-term dysphagia. The purpose of this study was to determine the risk factors for persistent postoperative dysphagia at 1 year after surgery.

Methods

All patients who underwent antireflux surgery were entered into a prospectively maintained database. After obtaining institutional review board approval, the database was queried to identify patients who underwent primary antireflux surgery and were at least 1 year from surgery. Postoperative severity of dysphagia was evaluated using a standardized questionnaire (scale 0–3). Patients with scores of 2 or 3 were defined as having significant dysphagia.

Results

A total of 316 consecutive patients underwent primary antireflux surgery by a single surgeon. Of these, 219 patients had 1 year postoperative symptom data. Significant postoperative dysphagia at 1 year was reported by 19 (9.1%) patients. Thirty-eight patients (18.3%) required postoperative dilation for dysphagia. Multivariate logistic regression analysis identified preoperative dysphagia (odds ratio (OR), 4.4; 95% confidence interval (CI), 1.2–15.5; p = 0.023) and preoperative delayed esophageal transit by barium swallow (OR, 8.2; 95% CI, 1.6–42.2; p = 0.012) as risk factors for postoperative dysphagia. Female gender was a risk factor for requiring dilation during the early postoperative period (OR, 3.6; 95% CI, 1.3–10.2; p = 0.016). No correlations were found with preoperative manometry. There also was no correlation between a need for early dilation and persistent dysphagia at 1 year of follow-up (p = 0.109).

Conclusions

Patients with preoperative dysphagia and delayed esophageal transit on preoperative contrast study were significantly more likely to report moderate to severe postoperative dysphagia 1 year after antireflux surgery. This study confirms that the manometric criteria used to define esophageal dysmotility are not reliable to identify patients at risk for postfundoplication dysphagia, and that there is need for standardization of contrast swallow assessment of esophageal function.

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Disclosures

Drs. Tsuboi, Mittal, Legner, Yano, Dworak, and Lee have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA

    Kazuto Tsuboi, Tommy H. Lee, András Legner, Fumiaki Yano & Sumeet K. Mittal

  2. Department of Radiology, Creighton University Medical Center, Omaha, NE, USA

    Thomas Dworak

Authors
  1. Kazuto Tsuboi
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  2. Tommy H. Lee
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  3. András Legner
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  4. Fumiaki Yano
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  6. Sumeet K. Mittal
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Correspondence to Sumeet K. Mittal.

Additional information

This paper was based on a presentation at the congress of the Society of American Gastrointestinal and Endoscopic Surgeons, Landover, MD, April, 2010.

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Tsuboi, K., Lee, T.H., Legner, A. et al. Identification of risk factors for postoperative dysphagia after primary anti-reflux surgery. Surg Endosc 25, 923–929 (2011). https://doi.org/10.1007/s00464-010-1302-9

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