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A Tailored Approach to Laparoscopic Fundoplication: Outcomes in Patients with Esophageal Dysmotility

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Esophageal dysmotility is a common finding in patients being evaluated for antireflux surgery, although its implication remains unclear. We aimed to evaluate outcomes of patients with esophageal dysmotility after fundoplication.

Methods

A retrospective review of a prospective quality-database was performed. All patients who underwent laparoscopic Nissen (NF) or Toupet (TF) fundoplication were included. Esophageal dysmotility was defined using the Chicago Classification v4.0 and conventional metrics, creating three sub-groups: ineffective esophageal motility (IEM), distal/diffuse esophageal spasm (DES), and hypercontractile esophagus (HE). Quality of life (QOL) outcomes were measured by the Reflux Severity Index (RSI), Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL), and Dysphagia Scores.

Results

Of 487 patients included, 99 (20.3%) had esophageal dysmotility (49 IEM, 40 DES, 10 HE). While a majority in the dysmotility group (81.8%) underwent TF, most patients in the normal group (76.5%) underwent NF (p < 0.001). On multivariable analysis controlling for sex, age, BMI, hiatal hernia, and surgery type, the normal group had higher Dysphagia Scores at 3 weeks (2.2 ± 0.9 vs. 1.7 ± 0.8, p < 0.001), but not at 6-month, 1-year, 2-year, or 5-year follow-up. There were no differences between normal and dysmotility groups in terms of RSI or GERD-HRQL scores at any time point. Patients with different sub-types of esophageal dysmotility had similar QOL outcomes at all time points.

Conclusion

Patients with esophageal dysmotility had similar outcomes compared to those with normal motility after fundoplication, suggesting the tailored approach favoring partial fundoplication for patients with dysmotility as part of an appropriate treatment algorithm.

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References

  1. Worrell SG, Greene CL, DeMeester TR (2014) The State of Surgical Treatment of Gastroesophageal Reflux Disease after Five Decades. Journal of the American College of Surgeons 219:819–830 . https://doi.org/10.1016/j.jamcollsurg.2014.05.018

    Article  PubMed  Google Scholar 

  2. Shaw JM, Bornman PC, Callanan MD, Beckingham IJ, Metz DC (2010) Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial. Surg Endosc 24:924–932 . https://doi.org/10.1007/s00464-009-0700-3

    Article  PubMed  Google Scholar 

  3. Dallemagne B, Weerts J, Markiewicz S, Dewandre J-M, Wahlen C, Monami B, Jehaes C (2006) Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 20:159–165 . https://doi.org/10.1007/s00464-005-0174-x

    Article  CAS  PubMed  Google Scholar 

  4. Schwameis K, Zehetner J, Rona K, Crookes P, Bildzukewicz N, Oh DS, Ro G, Ross K, Sandhu K, Katkhouda N, Hagen JA, Lipham JC (2017) Post-Nissen Dysphagia and Bloating Syndrome: Outcomes After Conversion to Toupet Fundoplication. J Gastrointest Surg 21:441–445 . https://doi.org/10.1007/s11605-016-3320-y

    Article  PubMed  Google Scholar 

  5. Chrysos E, Tsiaoussis J, Zoras OJ, Athanasakis E, Mantides A, Katsamouris A, Xynos E (2003) Laparoscopic surgery for gastroesophageal reflux disease patients with impaired esophageal peristalsis: total or partial fundoplication? Journal of the American College of Surgeons 197:8–15 . https://doi.org/10.1016/S1072-7515(03)00151-0

    Article  PubMed  Google Scholar 

  6. Armijo PR, Hennings D, Leon M, Pratap A, Wheeler A, Oleynikov D (2019) Surgical Management of Gastroesophageal Reflux Disease in Patients with Severe Esophageal Dysmotility. J Gastrointest Surg 23:36–42 . https://doi.org/10.1007/s11605-018-3968-6

    Article  PubMed  Google Scholar 

  7. Martinucci I, de Bortoli N, Giacchino M, Bodini G, Marabotto E, Marchi S, Savarino V, Savarino E (2014) Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther 5:86–96 . https://doi.org/10.4292/wjgpt.v5.i2.86

    Article  PubMed  PubMed Central  Google Scholar 

  8. Strate U, Emmermann A, Fibbe C, Layer P, Zornig C (2008) Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc 22:21–30 . https://doi.org/10.1007/s00464-007-9546-8

    Article  CAS  PubMed  Google Scholar 

  9. Hunter JG, Swanstrom L, Waring JP (1996) Dysphagia after laparoscopic antireflux surgery. The impact of operative technique. Ann Surg 224:51–57

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Lund RJ, Wetcher GJ, Raiser F, Glaser K, Perdikis G, Gadenstätter M, Katada N, Filipi CJ, Hinder RA (1997) Laparoscopic toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility. J Gastrointest Surg 1:301–308 . https://doi.org/10.1016/S1091-255X(97)80049-2

    Article  CAS  PubMed  Google Scholar 

  11. Xiao Y, Kahrilas PJ, Kwasny MJ, Roman S, Lin Z, Nicodème F, Lu C, Pandolfino JE (2012) High Resolution Manometry Correlates of Ineffective Esophageal Motility. Am J Gastroenterol 107:1647–1654 . https://doi.org/10.1038/ajg.2012.286

    Article  PubMed  PubMed Central  Google Scholar 

  12. Novitsky YW, Wong J, Kercher KW, Litwin DEM, Swanstrom LL, Heniford BT (2007) Severely disordered esophageal peristalsis is not a contraindication to laparoscopic Nissen fundoplication. Surg Endosc 21:950–954 . https://doi.org/10.1007/s00464-006-9126-3

    Article  CAS  PubMed  Google Scholar 

  13. Heider TR, Behrns KE, Koruda MJ, Shaheen NJ, Lucktong TA, Bradshaw B, Farrell TM (2003) Fundoplication improves disordered esophageal motility. J Gastrointest Surg 7:159–163 . https://doi.org/10.1016/s1091-255x(02)00145-2

    Article  PubMed  Google Scholar 

  14. Pizza F, Rossetti G, Rosetti G, Del Genio G, Maffettone V, Brusciano L, Del Genio A (2008) Influence of esophageal motility on the outcome of laparoscopic total fundoplication. Dis Esophagus 21:78–85 . https://doi.org/10.1111/j.1442-2050.2007.00756.x

    Article  CAS  PubMed  Google Scholar 

  15. Ravi N, Al-Sarraf N, Moran T, O’Riordan J, Rowley S, Byrne PJ, Reynolds JV (2005) Acid normalization and improved esophageal motility after Nissen fundoplication: equivalent outcomes in patients with normal and ineffective esophageal motility. The American Journal of Surgery 190:445–450 . https://doi.org/10.1016/j.amjsurg.2005.05.040

    Article  PubMed  Google Scholar 

  16. Z Tian B Wang C Shan W Zhang D Jiang M Qiu (2015) A Meta-Analysis of Randomized Controlled Trials to Compare Long-Term Outcomes of Nissen and Toupet Fundoplication for Gastroesophageal Reflux Disease PLoS One 10. https://doi.org/10.1371/journal.pone.0127627

  17. Fibbe C, Layer P, Keller J, Strate U, Emmermann A, Zornig C (2001) Esophageal Motility in Reflux Disease Before and After Fundoplication: A Prospective, Randomized, Clinical, and Manometric Study. Gastroenterology 121:5–14 . https://doi.org/10.1053/gast.2001.25486

    Article  CAS  PubMed  Google Scholar 

  18. Belafsky PC, Postma GN, Koufman JA (2002) Validity and Reliability of the Reflux Symptom Index (RSI). Journal of Voice 16:274–277 . https://doi.org/10.1016/S0892-1997(02)00097-8

    Article  PubMed  Google Scholar 

  19. Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183:217–224

    CAS  PubMed  Google Scholar 

  20. Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 20:130–134 . https://doi.org/10.1111/j.1442-2050.2007.00658.x

    Article  CAS  PubMed  Google Scholar 

  21. Gunter RL, Shada AL, Funk LM, Wang X, Greenberg JA, Lidor AO (2017) Long-Term Quality of Life Outcomes Following Nissen Versus Toupet Fundoplication in Patients with Gastroesophageal Reflux Disease. Journal of Laparoendoscopic & Advanced Surgical Techniques 27:931–936 . https://doi.org/10.1089/lap.2017.0232

    Article  Google Scholar 

  22. Hajibandeh S, Hajibandeh S, Pugh M, Winters D, Hobbs N, Tarazi M, Panda N, Dalmia S, Mansour M, Malik S (2018) Impact of Toupet Versus Nissen Fundoplication on Dysphagia in Patients With Gastroesophageal Reflux Disease and Associated Preoperative Esophageal Dysmotility: A Systematic Review and Meta-Analysis. Surg Innov 25:636–644 . https://doi.org/10.1177/1553350618799549

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA

    Harry J. Wong, Mason Hedberg, Mikhail Attaar, Bailey Su, Kristine Kuchta, John G. Linn, Stephen P. Haggerty & Michael B. Ujiki

  2. Department of Surgery, University of Chicago Medicine, Chicago, IL, USA

    Harry J. Wong, Mikhail Attaar & Bailey Su

  3. University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Mason Vierra

  4. Department of Gastroenterology, NorthShore University HealthSystem, Evanston, IL, USA

    Gene Chiao

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  1. Harry J. Wong
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Correspondence to Harry J. Wong.

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Conflict of Interest

The authors have no personal or financial conflict of interests related to this work to disclose. Drs Linn, Haggerty, and Ujiki receive payment for lectures from Gore. Dr Haggerty is a paid consultant to Medtronic. Dr Ujiki is a scientific board member for Boston Scientific, is a paid consultant for Olympus and Cook, and receives payment for lectures from Medtronic and Erbe. Drs Wong, Su, Attaar, Hedberg, and Kristine Kuchta have no financial support to disclose.

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This manuscript was presented at the 2nd Annual Illinois Surgical Conference by the Illinois Chapter of the American College of Surgeons on Saturday, April 24, 2021.

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Wong, H.J., Vierra, M., Hedberg, M. et al. A Tailored Approach to Laparoscopic Fundoplication: Outcomes in Patients with Esophageal Dysmotility. J Gastrointest Surg 26, 2426–2433 (2022). https://doi.org/10.1007/s11605-022-05452-4

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