Dysphagia after laparoscopic antireflux surgery: what is the true role of fundoplication in its production

Introduction:Dysphagia following antireflux surgery is often seen as an unavoidable sequelae of surgery. This study undertook a detailed evaluation of dysphagia before and after laparoscopic fundoplication. Methods:312 patients undergoing laparoscopic fundoplication under-went prospective assessment of dysphagia using a composite dysphagia score (score 0—no dysphagia, score 45—complete dysphagia) at structured interview before and 6 months after surgery. Results:The median dysphagia score was 0 (range 0–40) pre-operatively and 0 (range 0–45) 6 months post-operatively. Overall, 98 (32%)patients’ dysphagia score improved, 132 (42%) patients’ dysphagia score remained unchanged and 82 (26%) patients’ dysphagia score deteriorated 6 months after surgery. 188 (60%) patients had no dysphagia(a score of 0) before surgery. Six months after surgery, 59 (31%) of these patients noted varying degrees of dysphagia. 124 (40%) patients had a dysphagia score >0 before surgery. 98 (79%) patients’ dysphagia score improved, 3 (2.4%) patients’ dysphagia score remained unchanged and23 (19%) patients’ dysphagia score deteriorated 6 months after surgery. In44 patients with dysphagia before surgery, their score fell to 0 (ie no dysphagia) at 6 months after surgery. Conclusion:Dysphagia is a common symptom prior to fundoplication.After fundoplication, new or worsening dysphagia is more likely to occur in patients with no dysphagia pre-operatively. Furthermore, those patients with dysphagia prior to surgery are more likely to have an improvement in their dysphagia rather than a deterioration following fundoplication