K. Vande Walle1, L. M. Funk1, Y. Xu1, J. Greenberg1, A. Shada1, A. Lidor1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: Laparoscopic fundoplication is the gold standard operation for control of gastroesophageal reflux disease. It has been suggested that persistent postoperative dysphagia is increased in Nissen fundoplication compared to partial fundoplication (Toupet, Dor). We aimed to determine risk factors for persistent postoperative dysphagia, specifically examining type of fundoplication, to inform operative planning.
Methods: Patients experiencing gastroesophageal reflux symptoms who underwent laparoscopic Nissen, Toupet, or Dor fundoplication between January 2009 and July 2016 were identified from our single academic institutional foregut surgery database. A dysphagia score was obtained by administering a standardized quality of life survey in clinic or by telephone. Persistent dysphagia was defined as a difficulty swallowing score ≥ 1 (noticeable) on a scale from 0 (no symptoms) to 5 (incapacitating) at least one year postoperatively. Adjusted odds ratios (OR) of persistent dysphagia among those who underwent Nissen compared to partial fundoplication with 95% confidence intervals (CI) were calculated in multivariate logistic regression models. The multivariate logistic regression model was adjusted for sex, age, body mass index (BMI), and redo operation.
Results: Of 441 patients in the database who met the inclusion criteria, 255 had at least one year of follow-up (response rate = 57.8%). The median follow-up interval was 3 years. 45.1% of patients underwent Nissen fundoplication and 54.9% underwent partial fundoplication. Persistent postoperative dysphagia was present in 25.9% (n=66) of patients. On adjusted analysis, there was no statistically significant association between the type of fundoplication (Nissen vs. partial) and the likelihood of dysphagia (Table 1).
Conclusion: The likelihood of persistent dysphagia was not associated with the type of fundoplication (Nissen vs. partial). While many surgeons believe partial fundoplication decreases the risk of persistent postoperative dysphagia compared to Nissen fundoplication, our study demonstrated equivalent rates of persistent postoperative dysphagia. This suggests that in patients who are equivalent candidates for either a Nissen or partial fundoplication, Nissen fundoplication is a sound choice for an antireflux operation.
