Suture-induced dysphagia: the role of endoscopy in diagnosis and therapy.

Abstract

Dysphagia is a major postoperative complication of surgery on the distal esophagus and proximal stomach. 1 Peters JH DeMeester TR Crookes P Oberge S Shoop MDV Hagen JA Bremner CG The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication. Ann Surg. 1998; 228: 40-50 Crossref PubMed Scopus (256) Google Scholar , 2 Wo JM Trus TL Richardson WS Hunter JG Branum GD Mauren SJ Waring JP Evaluation and management of postfundoplication dysphagia. Am J Gastroenterol. 1996; 91: 2318-2322 PubMed Google Scholar After Nissen fundoplication, dysphagia from edema, in response to ingestion of both solids and liquids, is reported during the early postoperative period (<3 months) by up to 50% of patients. In the late period (>3 months), dysphagia, mainly for solids, occurs in up to 10% of patients because of the following: a tight wrap, disrupted wrap, slipped or migrated wrap, recurrent peptic stricture, or a fibrostenotic stricture as a result of electrosurgical injury or technical error. 3 Hinder RA Klingler PJ Perdikis G Smith SL Surg Clin North Am. 1997; 77: 1083-1098 Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar , 4 Johnson DA Younes Z Hogan WJ Endoscopic assessment of hiatal hernia repair. Gastrointest Endosc. 2000; 52: 650-659 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar , 5 Waring JP Postfundoplication complications: Prevention and management. Gastroenterol Clin North Am. 1999; 28: 1007-1019 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 6 Urschel JD Complications of antireflux surgery. Am J Surg. 1993; 166: 68-70 Abstract Full Text PDF PubMed Scopus (68) Google Scholar , 7 Hanimann B Sacher P Stauffer UG Complications and long-term results of the Nissen fundoplication. Euro J Pediatr Surg. 1993; 3: 12-14 Crossref PubMed Scopus (13) Google Scholar , 8 DeMeester TR Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients. Ann Surg. 1986; 204: 9-20 Crossref PubMed Scopus (786) Google Scholar However, there are few reports of erosion of surgical material into the esophagus as a cause of late postoperative dysphagia. 3 Hinder RA Klingler PJ Perdikis G Smith SL Surg Clin North Am. 1997; 77: 1083-1098 Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar , 4 Johnson DA Younes Z Hogan WJ Endoscopic assessment of hiatal hernia repair. Gastrointest Endosc. 2000; 52: 650-659 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar , 9 Arendt T Stuber E Monig H Folsch UR Katsoulis S Dysphagia due to transmural migration of surgical material into the esophagus nine years after Nissen fundoplication. Gastrointest Endosc. 2000; 51: 607-610 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar The initial reports of this complication pertain to the Angelchik antireflux prosthesis. 10 Lilly MP Slafky F Thompson WR Intraluminal erosion and migration of the Angelchic antireflux prosthesis. Arch Surg. 1984; 119: 849-853 Crossref PubMed Scopus (43) Google Scholar , 11 Souka H Karanjia ND Endoscopic removal of an Angelchic prosthesis after migration through the gastroesophageal junction. Endoscopy. 1995; 27: 464-467 Crossref PubMed Scopus (9) Google Scholar Two patients are described with an unusual case of postoperative dysphagia: a chronic inflammatory mass or ulcer with stenosis caused by multiple, partially extruded sutures at the esophagogastric junction. The dysphagia resolved completely after endoscopic suture removal in one patient and after combined endoscopic-laparoscopic removal in the other.