Does Intraesophageal Bougie Use Prevent Post-operative Dysphagia in Laparoscopic Nissen Fundoplication?
Background: It is yet unknown what contributes to the variable degrees of post-operative dysphagia following a laparoscopic Nissen fundoplication (LNF). Previous studies have not found a contributing factor to post-operative dysphagia. This study reviews the effect of procedure practices, especially Bougie device use, that could be possible contributors to post-operative dysphagia.
Methods: A retrospective study was conducted of patients who had undergone LNF procedures from 2012 – 2014. All demographic and procedure characteristics were recorded and compared between groups with Bougie (WB) and without Bougie (WOB). Association of all available factors with any post-operative dysphagia were evaluated using univariate and multivariate logistic regression analysis.
Results: A total of 127 patients (89 female) were operated on by 4 surgeons. A Bougie device was used in 99 (78%) cases, and 38 (30%) patients experienced some degree of post-operativedysphagia. There was no significant difference between WB and WOB groups demographically. WOB cases tended to have a longer operative time (134.3 min ± 43.6 vs 95.8 min ± 46.3; P<0.001) and estimated blood loss (47.5 mL, (95%CI:28 – 68) vs 24 mL (95%CI: 19 – 29, P=0.001). Post-operative dysphagia was not associated with use of Bougie device (OR=0.99 (0.38-3.44), P=0.81). The success rate of the dilation procedure was not associated with prior utilization of Bougie in the primary surgery (OR= 0.9, 95% CI: 0.12-6.5).
Conclusions: Use of Bougie was correlated with shorter operative time and less bleeding; however, post-operative dysphagia does not appear to be associated with its use in laparoscopic Nissen fundoplication. Data analysis did not suggest any other contributors to post-operative dysphagia. Further studies with larger number of surgeons are suggested in order to evaluate the effect of surgeon experience on outcomes.
Copyright (c) 2022 Victoria Martine, Mohammad Kalantar, Spyridon Giannopoulos, Dimitrios Stefanidis, MD, PhD
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