Abstract
PurposeTo evaluate the diagnostic performance of swallowing MRI of the gastroesophageal junction (GEJ) in the postoperative care of patients after laparoscopic antireflux surgery (LARS)Material and methodsIn this institutional review board-approved prospective study, 79 symptomatic patients (mean age, 52.3 years; range, 26–80 years) were evaluated after laparoscopic Nissen fundoplication. MRI findings were correlated with revision surgery, endoscopy, and high-resolution manometry (HRM) as standard of reference. MRI was performed on a 3.0-T unit using T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) sequences for anatomical assessment of the GEJ followed by dynamic MR swallowing (fast low-angle shot sequences). Four independent readers (two radiologists, two surgeons) rated 83 MR scans according to defined criteria, such as wrap disruption, slipping, recurrent hiatal hernia, and esophageal motility disorder.ResultsWrap disruption was correctly diagnosed concordantly with the standard of reference in 87.8%, slipping in 81.5%, and recurrent hiatal hernia in 84.9% of the cases. For esophageal motility disorder, MRI interpretation was consistent with manometry in 66.2% of the subjects. Interobserver analysis showed substantial agreement for recurrent hiatal hernia (k = 0.703), moderate agreement for wrap disruption (k = 0.585), and fair agreement for motility disorder and slipping (k = 0.234 and k = 0.200, respectively).ConclusionMR swallowing readily depicts the major failure mechanisms of LARS and has good reliability even in non-experienced readers.Key Points• MR swallowing accurately readily depicts the major failure mechanisms of laparoscopic antireflux surgery and has good reliability even in non-experienced readers.• It should be included in the preoperative workup for revision surgery after fundoplication.• It will be of great benefit to surgeons in considering and planning a reoperation.
Highlights
Since its introduction in 1991, laparoscopic Nissen fundoplication has become the most common procedure in antireflux surgery [1] and long-term follow-up studies of 5 years and longer have shown a satisfactory rate of 93% [2]
MR swallowing accurately readily depicts the major failure mechanisms of laparoscopic antireflux surgery and has good reliability even in non-experienced readers. It should be included in the preoperative workup for revision surgery after fundoplication
While different diagnostic follow-up options, such as manometry studies and endoscopy, exist, dynamic MR imaging was recently introduced as a promising non-invasive method for evaluating the gastroesophageal junction after Nissen fundoplication [6]
Summary
Since its introduction in 1991, laparoscopic Nissen fundoplication has become the most common procedure in antireflux surgery [1] and long-term follow-up studies of 5 years and longer have shown a satisfactory rate of 93% [2]. The symptoms should resolve within 6 weeks; otherwise, a postsurgical failure as a possible reason for the symptoms has to be considered. Postsurgical failure and its definition have been extensively discussed in the literature [4]. While different diagnostic follow-up options, such as manometry studies and endoscopy, exist, dynamic MR imaging was recently introduced as a promising non-invasive method for evaluating the gastroesophageal junction after Nissen fundoplication [6]. This method may serve as an accessory method for the evaluation of esophageal motility [7, 8]
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