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Preoperative High-Resolution Manometry Criteria are Associated with Dysphagia After Nissen Fundoplication

  • Steve R. Siegal
  • Christy M. Dunst
  • Ben Robinson
  • Elizabeth N. Dewey
  • Lee L. Swanstrom
  • Steven R. DeMeester
Original Scientific Report
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Abstract

Background

Dysphagia after Nissen fundoplication is challenging for patients. High-resolution manometry (HRM) has rarely been studied preoperatively to determine whether manometry values correlated with postoperative dysphagia after fundoplication. We aim to determine whether HRM criteria could predict dysphagia after Nissen fundoplication.

Methods

A retrospective review of single-institution laparoscopic Nissen fundoplications (LNF) from 2013 to 2015 was completed. Dysphagia was graded using a standard scale. Four groups were: those with new postoperative dysphagia (ND), never had dysphagia (NV), continued dysphagia (CD), and resolved dysphagia (RD). Manometry criteria included distal contractile integral (DCI), contraction front velocity (CFV), distal latency (DL), integrated relaxation pressure (IRP), percent peristalsis (PP), and distal esophageal contraction amplitude (DECA). Statistical bootstrapping was used to power sample sizes for ANOVA analysis.

Results

Ninety-four patients were included in the original cohort. Statistical bootstrapping sample size was 2992 patients. Among patients who did not have dysphagia prior to LNF, no HRM metric was associated with developing new dysphagia. Among those with dysphagia prior to LNF, a higher DCI, CFV, DL, PP, and DECA were associated with resolution of dysphagia. The RD group was 2.77 times more likely to have a DCI ≥ 1000 mmHg-s-cm compared with the CD group.

Conclusions

HRM criteria could not predict the development of postoperative dysphagia. However, in those with preoperative dysphagia and strong manometry criteria, dysphagia is more likely to resolve after Nissen fundoplication. Meanwhile, in those with preoperative dysphagia and weak manometry, dysphagia may persist and these patients may be better served with a partial fundoplication.

Notes

Compliance with ethical standards

Conflict of interest

Authors SS, CD, BR, ED, LS, SD have no disclosure or conflicts of interest that pertain to this research paper.

Supplementary material

268_2018_4870_MOESM1_ESM.pdf (96 kb)
Online Resource 1. Literature Database Search for Normative High Resolution Manometry Values (PDF 96 kb)
268_2018_4870_MOESM2_ESM.pdf (90 kb)
Online Resource 2. Caption: Statistical Analysis Software (SAS) code used for bootstrapping and to generate samples (PDF 90 kb)

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Steve R. Siegal
    • 1
  • Christy M. Dunst
    • 2
  • Ben Robinson
    • 2
  • Elizabeth N. Dewey
    • 1
  • Lee L. Swanstrom
    • 2
  • Steven R. DeMeester
    • 2
  1. 1.Department of SurgeryOregon Health & Science UniversityPortlandUSA
  2. 2.Gastrointestinal and Minimally Invasive SurgeryThe Oregon ClinicPortlandUSA

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