Prospective evaluation of dysphagia before and after laparoscopic Nissen fundoplication without routine division of short gastrics.

The incidence and severity of dysphagia before and 6 months after laparoscopic Nissen fundoplication without routine division of short gastric vessels are presented. Laparoscopic Nissen fundoplication was undertaken in 195 patients over 32 months with 116 patients who had prospective follow-up longer than 6 months. Patients underwent a 24-h pH recording, esophageal manometry, and symptom score assessment before and 6 months after surgery. There was a significant (p < 0.0001) improvement in the percent of reflux in 24-h (8.61 +/- 0.74 to 0.68 +/- 0.12), lower esophageal pressure (8.53 +/- 0.51 to 23.11 +/- 1.1 mm Hg), and reflux symptom scores (40.97 +/- 1.13 to 12.11 +/- 1.1) at 6 months. A similar improvement (p < 0.0001) was also observed in the dysphagia symptom score (4.58 +/- 0.38 to 1.96 +/- 0.32), with more than half the patients reporting improvement after surgery. No correlation was observed between the change in dysphagia score and the postoperative lower esophageal pressure or esophageal motor function. These data suggest that the incidence of clinically significant dysphagia after laparoscopic Nissen fundoplication, even without division of short gastric vessels, is low. Improvement in the dysphagia score after surgery is interesting and warrants further investigation.