Complete fundoplication has similar long-term results in patients with and without esophageal body dysmotility |
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Authors: | B Goss Y Shacham A Szold |
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Institution: | (1) Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel 04239, IL;(2) Semmelweiss Medical University, Budapest, Hungary, HU;(3) Endoscopic Surgery Service, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel, IL |
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Abstract: | Background: Partial fundoplication is advocated for the treatment of gastroesophageal reflux disease in patients with poor
esophageal body function. We hypothesized that a complete floppy wrap may be just as safe in patients with poor esophageal
motility. Methods: A retrospective, case-control study was performed on patients who underwent a complete fundoplication and
had poor esophageal motility. Study patients were matched with controls with normal esophageal body pressures according to
sex, age, and duration of reflux symptoms. Patients were followed up and interviewed using a modified symptom and life quality
questionnaire. Results: Twenty-two patients and 22 matched controls underwent a complete fundoplication. The mean esophageal
body pressure was 42.1 and 87.5 mmHg in the study and control groups, respectively (p <0.05). Average time to resolution of
dysphagia was 10.1 weeks in the study group and 12 weeks in the control group. All patients but 1 (control) graded their life
quality improvement as good to excellent. Conclusion: Our data suggest that a 360° fundoplication has similar long-term results
regardless of esophageal body motility. We suggest that a partial fundoplication may be reserved for patients with severe
esophageal body dysfunction. The role of manometry in the preoperative workup should be reassesed: it may be mandatory only
in patients with preoperative dysphagia or when achalasia is suspected. |
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