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Dysphagia After Laparoscopic Nissen Fundoplication: Incidence, Causes, Prevention, and Treatment

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Abstract

Laparoscopic Nissen fundoplication (LNF) is considered the surgical treatment of choice for gastroesophageal reflux disease (GERD). However, persistent dysphagia (PD) occurs in up to 20% of patients. The aim of this study was to evaluate the incidence of PD after LNF, the causes, and the methods of prevention and management. This study was a retrospective analysis of prospectively collected data. From April 1994 to November 2019, 868 patients underwent laparoscopic short-floppy Nissen fundoplication (LSFNF). A postoperative dysphagia score was obtained by using the “difficulty swallowing” question from the GERD-Health Related Quality of Life. The postoperative clinical outcomes were obtained from 822 to 868 patients (94.7%) after LSFNF. The mean follow-up period was 17.3 years (range 1–26). Only 12 patients (1.4%) with PD were treated. Seven patients (0.8%) required endoscopic dilatation. Too tight fundoplication was the most frequent cause of dysphagia. Dysphagia was resolved completely in all patients. Five patients (0.6%) required reoperation for prolonged dysphagia (three for a tight wrap and two for a tight esophageal hiatus) after failed dilatation attempts. All underwent laparoscopic conversion from Nissen procedure to Toupet with enlargement of hiatal opening in two. Dysphagia was resolved completely in all patients. Postoperative esophageal manometry was performed in all patients with PD. Pre- and postoperative manometric data were not significantly different between patients with moderate-severe PD, mild PD, and without dysphagia. PD is a common complication after LNF. The most frequent cause is too tight fundoplication. The LSFNF could prevent postoperative dysphagia.

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Authors and Affiliations

  1. Department of Biotechnological and Applied Clinical Science, General Surgery, San Salvatore Hospital, University of L’Aquila, 67100, L’Aquila, Coppito, Italy

    Mario Schietroma, Lucia Romano, Chiara Tomarelli, Francesco Carlei & Antonio Giuliani

  2. U.O.C. di Emergenza e D’Urgenza, San Salvatore Hospital, via L. Natali, 1, 67100, L’Aquila, Italy

    Emilio Tonelli

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  1. Mario Schietroma
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  2. Lucia Romano
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  3. Chiara Tomarelli
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  4. Francesco Carlei
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  5. Emilio Tonelli
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  6. Antonio Giuliani
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Correspondence to Lucia Romano.

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Schietroma, M., Romano, L., Tomarelli, C. et al. Dysphagia After Laparoscopic Nissen Fundoplication: Incidence, Causes, Prevention, and Treatment. Indian J Surg 84, 792–798 (2022). https://doi.org/10.1007/s12262-021-02973-1

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  • DOI: https://doi.org/10.1007/s12262-021-02973-1

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