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Postoperative Dysphagia Following Esophagogastric Fundoplication: Does the Timing to First Dilation Matter?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Postoperative dysphagia after anti-reflux surgery typically resolves in a few weeks. However, even after the initial swelling has resolved at 6 weeks, dysphagia can persist in 30% of patients necessitating esophageal dilation. The purpose of this study was to investigate the effect of esophageal dilation on postoperative dysphagia, the recurrence of reflux symptoms, and the efficacy of pneumatic dilations on postoperative dysphagia.

Methods

A prospectively collected database was reviewed for patients who underwent partial/complete fundoplication with/without paraesophageal hernia repair between 2006 and 2014. Patient age, sex, BMI, DeMeester score, procedure type, procedure duration, length of stay, postoperative dysphagia, time to first pneumatic dilation, number of dilations, and the need for reoperations were collected.

Results

The study included 902 consecutive patients, 71.3% females, with a mean age of 57.8 ± 14.7 years. Postoperative dysphagia was noted in 26.3% of patients, of whom 89% had complete fundoplication (p < 0.01). Endoscopic dilation was performed in 93 patients (10.3%) with 59 (63.4%) demonstrating persistent dysphagia. Recurrent reflux symptoms occurred in 35 (37.6%) patients who underwent endoscopic dilation.

Patients who underwent a dilation for symptoms of dysphagia were less likely to require a revisional surgery later than patients who had dysphagia but did not undergo a dilation before revisional surgery (17.2% vs 41.7%, respectively, p < 0.001) in the 4-year follow-up period. The duration of initial dilation from surgery was inversely related to the need for revisional surgery (p = 0.047), while more than one dilation was not associated with additive benefit.

Conclusion

One attempt at endoscopic dilation of the esophagogastric fundoplication may provide relief in patients with postoperative dysphagia and can be used as a predictive factor for the need of revision. However, there is an increased risk for recurrent reflux symptoms and revisional surgery may ultimately be indicated for control of symptoms.

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Acknowledgments

We thank our undergraduate student Keith Makhecha who assisted us with the literature search on the topic.

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Dimitrios I. Athanasiadis, Don Selzer, Dimitrios Stefanidis, Jennifer N. Choi & Ambar Banerjee

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  1. Dimitrios I. Athanasiadis
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  2. Don Selzer
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Correspondence to Ambar Banerjee.

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Conflict of Interest

Drs. Dimitrios I. Athanasiadis, Jennifer N. Choi, and Ambar Banerjee have no conflicts of interest or financial ties to disclose.

Dr. Selzer is a consultant for Cook Biotech and PolyNovo and has received research support by Bard; however, none of the research in the present report was funded by the above.

Dr. Dimitrios Stefanidis has received research support to institution by ExplORer Surgical Inc. and Bard; however, none of the research in the present report was funded by the above.

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Athanasiadis, D.I., Selzer, D., Stefanidis, D. et al. Postoperative Dysphagia Following Esophagogastric Fundoplication: Does the Timing to First Dilation Matter?. J Gastrointest Surg 25, 2750–2756 (2021). https://doi.org/10.1007/s11605-021-04930-5

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