Anti-reflux surgery

Abstract

New onset post fundoplication dysphagia is among the most significant potential adverse events following antireflux surgery. Although this occurs in a small number of patients, its prevention is important and largely possible. Importantly, the majority of patients with preoperative dysphagia, report an improvement in swallowing postoperatively. Early postoperative dysphagia is common and well tolerated; however, persistent or new onset dysphagia occurs in approximately 5-10% of patients. Patient selection, preoperative abnormalities and accurate construction of a short, loose fundoplication will help minimize the incidence of persistent postoperative dysphagia. Although adequate esophageal body contractility has received the vast majority of attention, careful study suggests that hiatal outflow resistance is among the most common reasons for new onset dysphagia. When persistent dysphagia causing severe dietary limitations or significant weight loss prompts treatment bougie dilation may be attempted, although its benefit remains untested in controlled studies. Most patients will improve with time. Remedial surgical correction including takedown of hiatal closure, reclosure and conversion to partial fundoplication may be occasionally necessary.