Management Strategies for Dysphagia Complicating Laparoscopic Nissen Fundoplication, Systematic Review

Abstract

Abstract Background Gastroesophageal reflux disease (GERD) is a common global disorder. Manifestations of the disease range from occasional episodes of heartburn and regurgitation to the more serious complications of stricture and Barrett’s esophagus. Most patients manage their symptoms with a combination of dietary and lifestyle modifications and overthe-counter or prescription medications. Aim of the Work This study aims to assess the incidence, etiology, diagnosis and management strategies for dysphagia following laparoscopic Nissen fundoplication. Patients and Methods Published studies discussing dysphagia as a complication of laparoscopic Nissen fundoplication. Patients developed dysphagia after laparoscopic Nissen fundoplication as primary anti-reflux surgery, the type of intervention was laparoscopic Nissen fundoplication. Types of outcome measures: Incidence, etiology, diagnosis and management strategies for dysphagia following laparoscopic Nissen fundoplication. The published English-language literature will be searched in the databases PUBMED, EMBASE, Google Scholar, Science direct and Cochrane Register of Controlled Trails (The Cochrane Library). The search terms will be employed: “Nissen fundoplication” “early dysphagia” “ late dysphagia”. Results In our present systematic review, we observed that the incidence of post-operative dysphagia after laparoscopic Nissen fundoplication among the included studies ranged from 8.2% to 42.8% with average percent of 33.2%. Transient postoperative dysphagia was more prominent in most of the included studies with average 52.8%, while persistent dysphagia was in reported in 47.2% of cases. In the present systematic review and meta-analysis, 707 of patients who developed postoperative dysphagia responded to conservative management with percent of 92.4%, while the remaining 58 patients required more invasive modalities. Endoscopic dilatation was performed in 54 (7.1%) of patients, while the remaining 4 patients (0.5%) were indicated for surgical reintervention. Conclusion Post laparoscopic Nissen fundoplication dysphagia is one of the most common complications, most cases present with a transient course that require no more than conservative management. In few conditions, more invasive procedures maybe required to control that condition.