Laparoscopic fundoplication for dysphagia and peptic esophageal stricture |
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Authors: | Hadar Spivak MD Timothy M Farrell MD Ted L Trus MD Gene D Branum MD J Patrick Waring MD John G Hunter MD FACS |
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Institution: | (1) Department of Surgery, Emory University School of Medicine, Atlanta, Ga.;(2) Department of Medicine, Emory University School of Medicine, Atlanta, Ga.;(3) Department of Surgery, Emory University Hospital, H124C, 1364 Clifton Road, NE, 30322 Atlanta, GA |
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Abstract: | Peptic esophageal stricture with dysphagia is a late manifestation of severe gastroesophageal reflux disease (GERD). Although
laparoscopic fundoplication is an effective antireflux operation, its efficacy for persons with peptic esophageal stricture
and dysphagia has not been well defined. The aim of this study was to evaluate outcomes after fundoplication in this subgroup
of GERD patients. Forty GERD patients with moderate, severe, or incapacitating dysphagia and peptic esophageal stricture were
compared to a control group of 121 GERD patients without significant dysphagia or stricture. Reflux symptom severity was scored
by each patient preoperatively and at most recent follow-up postoperatively (mean 1.5 years) using a scale ranging from 0
to 4 (0 = symptoms absent; 4 = symptoms incapacitating). Symptom scores were compared by the Wilcoxon rank-sum test. Postoperative
redilation and fundoplication failure rates were also determined. At a mean follow-up of 1.5 years after fundoplication, the
median dysphagia score had improved from 3 to 0 (P <0.001) in stricture patients and remained low (score 0) in the control group. The median heartburn score also improved from
3 to 0 (P <0.001) in stricture patients, with an identical response in the control group (P <0.001). Among dysphagia/stricture patients, 35 (87.5%) reported overall satisfaction and have not required secondary medical
treatment or esophageal dilation. Four patients (10%) have required endoscopic redilation for residual dysphagia and one (2.5%)
had re-operation for fundoplication herniation shortly after operation. Laparoscopic fundoplication is an effective therapy
for patients with dysphagia and peptic esophageal stricture.
Presented at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C., May 11–14,1997. |
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Keywords: | Esophageal stricture dilation laparoscopic fundoplication |
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