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Evaluation of post-operative dysphagia following anti-reflux surgery

  • 2021 SAGES Oral
  • Published:
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Abstract

Background

Anti-reflux surgery (ARS) has known long-term complications, including dysphagia, bloat, and flatulence, among others. The factors affecting the development of post-operative dysphagia are poorly understood. We investigated the correlation of intra-operative esophagogastric junction (EGJ) characteristics and procedure type with post-operative dysphagia following ARS.

Methods

Robotic ARS was performed on 197 consecutive patients with pathologic reflux utilizing EndoFLIP™ technology. Intraoperative EGJ measurements including distensibility index (DI), cross-sectional area (CSA), and high-pressure zone (HPZ) length were collected. Dysphagia was assessed pre-operatively and at 3 months post-operatively.

Results

The median pre-operative DI for all procedures was 2.6 (IQR 1.6–4.5) mm2/mmHg. There was no difference in post-operative DI between procedures [Hill: 0.9 (IQR 0.7–1.1) mm2/mmHg, Nissen: 1.0 (IQR 0.7–1.4) mm2/mmHg, Toupet: 1.2 (IQR 0.8–1.5) mm2/mmHg, Linx: 1.0 (IQR 0.7–1.2) mm2/mmHg, p = 0.24], whereas post-operative HPZ length differed by augmentation type [Hill: 3 (IQR 2.8–3) cm, Nissen: 3.5 (IQR 3–3.5) cm, Toupet: 3 (IQR 2.5–3.5) cm, Linx: 2.5 (IQR 2.5–3) cm, p = 0.032].

Eighty-nine patients (45.2%) had pre-operative dysphagia. Thirty-two patients (27.6%) reported any dysphagia at their 3-month post-operative visit and 12 (10.3%) developed new or worsening post-operative dysphagia [Hill: 2/18 (11.1%), Nissen: 2/35 (5.7%), Toupet: 4/54 (7.4%), Linx: 4/9 (44.4%), p = 0.006]. The median pre-operative and post-operative DI of patients who developed new or worsening dysphagia was 2.0 (IQR 0.9–3.8) mm2/mmHg and 1.2 (IQR 1.0–1.8) mm2/mmHg, respectively, and that of those who did not was 2.5 (IQR 1.6–4.0) mm2/mmHg and 1.0 (IQR 0.7–1.4) mm2/mmHg (p = 0.21 and 0.16, respectively).

Conclusions

Post-operative DI was similar between procedures, and there was no correlation with new or worsening post-operative dysphagia. Linx placement was associated with higher rates of new or worsening post-operative dysphagia despite a shorter post-procedure HPZ length and similar post-operative DI when compared to other methods of LES augmentation.

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Acknowledgements

Dr. Paul Christos was partially supported by the following Grant: Clinical and Translational Science Center at Weill Cornell Medical College (1-UL1-TR002384-01).

Funding

This study was internally funded.

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Authors and Affiliations

  1. Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA

    Jacques A. Greenberg, Dessislava I. Stefanova, Fernando Valle Reyes, Rodrigo C. L. Edelmuth, Lamia Harik, Jessica W. Thiesmeyer, Caitlin E. Egan, Federico Palacardo, Mengyuan Liu, Brendan M. Finnerty, Thomas J. Fahey III & Rasa Zarnegar

  2. Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

    Paul Christos

  3. Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

    Felice H. Schnoll-Sussman & Philip O. Katz

Authors
  1. Jacques A. Greenberg
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  2. Dessislava I. Stefanova
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  3. Fernando Valle Reyes
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  4. Rodrigo C. L. Edelmuth
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  5. Lamia Harik
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  6. Jessica W. Thiesmeyer
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  7. Caitlin E. Egan
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  8. Federico Palacardo
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  9. Mengyuan Liu
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  10. Paul Christos
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  11. Felice H. Schnoll-Sussman
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  12. Philip O. Katz
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  13. Brendan M. Finnerty
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  14. Thomas J. Fahey III
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  15. Rasa Zarnegar
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Corresponding author

Correspondence to Rasa Zarnegar.

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Disclosures

Dr. Rasa Zarnegar works as a consultant for Bard (BD). Dr. Philip Katz works as a consultant for Phathom Pharma. Jacques A. Greenberg, Dessislava I. Stefanova, Fernando Valle Reyes, Rodrigo C.L. Edelmuth, Lamia Harik, Jessica W. Thiesmeyer, Caitlin E. Egan, Federico Palacardo, Mengyuan Liu, Paul Christos, Felice H Schnoll-Sussman, Brendan M. Finnerty, and Thomas J. Fahey III have no conflicts of interest or financial ties to disclose.

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Greenberg, J.A., Stefanova, D.I., Reyes, F.V. et al. Evaluation of post-operative dysphagia following anti-reflux surgery. Surg Endosc 36, 5456–5466 (2022). https://doi.org/10.1007/s00464-021-08888-y

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