La disfagia persistente dopo plastica antireflusso laparoscopica

Postoperative dysphagia is an important complication after fundoplication for reflux disease, sometimes requiring re-operation. The aim of this retrospective study was to analyse our results after fundoplication performed for gastro-oesophageal reflux disease in order to assess the incidence of postoperative dysphagia, its therapy and the results in the treatment of this complication. We analysed the data of 276 patients who underwent fundoplication for gastro-oesophageal reflux disease. 8.7% of the patients had preoperative dysphagia and 9.1% had major postoperative dysphagia, during the follow-up. No correlation was found between preoperative and persistent postoperative dysphagia. Among patients with persistent postoperative dysphagia, 8 underwent endoscopic pneumatic dilatation, with symptom improvement in 62% of cases. Four patients underwent re-operation. The incidence of clinically significant persistent postoperative dysphagia was 3.6%. Over the same time period, another 11 patients underwent re-operation for persistent dysphagia after antireflux surgery performed elsewhere. Redo surgery was done after a median period of 12 months from the first operation, 77% of re-operated patients obtaining good results. Good results were obtained when an anatomical defect causing dysphagia could be detected. In conclusion, less than 5% of patients submitted to antireflux surgery present persistent postoperative dysphagia. Endoscopic pneumatic dilatation is successful in one-third of the patients. Re-operation gives good results when an anatomical defect causing dysphagia is found. Re-operation for failed fundoplication achieves symptom improvement in a significant percentage of patients (75%).