Determination of causes of post-operative dysphagia after anti-reflux surgery based on intra-operative planimetry

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发表日期：

2024年8月5日

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Hala Al Asadi,
Haythem Najah,
Ying Li,
Teagan Marshall,
Niloufar Salehi,
Anjani Turaga,
Brendan M. Finnerty,
Thomas J. Fahey III,
Rasa Zarnegar

摘要

Introduction

Dysphagia after anti-reflux surgery (ARS) is one of the most common indications for re-operative anti-reflux surgery and a leading cause of patient dissatisfaction. Unfortunately, the factors affecting its development are poorly understood. We investigated the correlation between pre-operative manometric and the intra-operative impedance planimetry (EndoFLIP™) measurements and development of post-operative dysphagia.

Methods

A review of patients who underwent index robotic ARS in our institution. Patients who underwent pre-operative manometry and intra-operative EndoFLIP™ were included in our study. Dysphagia was assessed pre-operatively and at 3-month after surgery.

Results

Fifty-five patients (26.9%) reported post-operative dysphagia, and 34 (16.6%) reported new or worsening dysphagia. On pre-operative manometry, patients with post-operative dysphagia had a lower distal contractile integral [868.7 (IQR 402.2–1447) mmHg s cm vs 1207 (IQR 612.1–2111) mmHg s cm, p = 0.006) and lower esophageal sphincter (LES) pressure [14.7 IQR (8.9–23.6) mmHg vs 20.7 IQR (10.2–32.6) mmHg, p = 0.01] compared to those without post-operative dysphagia. They were also found to have higher pre-operative cross-sectional surface area (CSA) [83 IQR (44.5–112) mm² vs 66 IQR (42–93) mm², p = 0.02], and distensibility index (DI) [4.2 IQR (2.2–5.5) mm²/mmHg vs 2.9 IQR (1.6–4.6) mm²/mmHg, p = 0.003] compared to patients without post-operative dysphagia. Additionally, the decrease in CSA [− 34 (− 18.5, − 74.5) mm² vs − 26.5 (− 10.5, − 53.7) mm², p = 0.03] and DI [− 2.3 (− 1.2, − 3.7) mm²/mmHg vs − 1.6 (− 0.7, − 3.3) mm²/mmHg, p = 0.03] measurements were greater in patients with post-operative dysphagia.

Conclusion

Patients who developed dysphagia post-operatively had poorer pre-operative motility and a greater change in LES characteristics intra-operatively. This finding suggests the utility of pre-operative manometry and intra-operative EndoFLIP in identifying patients at risk of developing dysphagia post-operatively.