Dysphagia after antireflux surgery

Abstract

Background: Dysphagia is experienced by many patients after antireflux surgery. This literature review examines factors associated with the development, prediction and management of postoperative dysphagia. Methods: Published studies examining issues related to dysphagia, gastro-oesophageal reflux and fundoplication were reviewed. Results: Postoperative dysphagia is usually temporary but proves troublesome for 5–10 per cent of patients. Technical modifications, such as a partial wrap, division of short gastric vessels and method of hiatal closure, have not conclusively reduced its incidence. There is no reliable preoperative test to predict dysphagia. Conclusion: It is uncertain whether postoperative dysphagia arises from patient predilection or is largely a consequence of mechanical changes created by fundoplication. Anatomical errors account for a significant proportion of patients referred for correction of dysphagia but these are uncommon in large single-institution studies. Abnormal manometry cannot predict dysphagia and, on current evidence, ‘tailoring’ the operation does not prevent its occurrence.