World Journal of Laparoscopic Surgery

Register      Login

VOLUME 15 , ISSUE 2 ( May-August, 2022 ) > List of Articles

Original Article

Dysphagia after Bougie-guided Crural Repair in Laparoscopic Nissen Fundoplication

Ahmed Samy Omar, Medhat Helmy Khalil

Keywords : Bougie, Dysphagia, Gastroesophageal reflux, Hiatal hernia, Nissen fundoplication

Citation Information : Omar AS, Khalil MH. Dysphagia after Bougie-guided Crural Repair in Laparoscopic Nissen Fundoplication. World J Lap Surg 2022; 15 (2):140-144.

DOI: 10.5005/jp-journals-10033-1520

License: CC BY-NC 4.0

Published Online: 16-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Purpose: Nissen fundoplication is still assumed as the perfect lifelong management for gastroesophageal reflux disease (GERD). Despite the marked progress in performing the operation laparoscopically, dysphagia remains the most common postoperative morbidity. The use of an intraesophageal bougie during fundoplication to decrease the risk of postoperative persistent dysphagia (PD) by a forming proper tension-free wrap has been reported before in the literature. However, the aim of our study was to highlight the role of using a bougie in allowing a more guided way to repair the crura and avoiding blinded posterior repair, and the effect of that in reducing the incidence of postoperative PD in laparoscopic Nissen fundoplication. Materials and methods: A prospective study including 40 patients undergoing laparoscopic Nissen fundoplication for repairing hiatal hernia with refractory GERD. The crural repair was guided by 50 Fr bougie. Postoperative collection of GERD–health-related quality of life (GERD–HRQL) questionnaire was done at 1 and 6 months for all the patients. The postoperative dysphagia was assessed regarding both severity and frequency. Results: The GERD symptoms significantly improved in all patients, with marked postoperative satisfaction. No patients required dilation for postoperative dysphagia. Ten patients (25%) had mild dysphagia that resolved with conservative management, but no recurrence of GERD symptoms was observed. Conclusion: Laparoscopic Nissen fundoplication is more efficient on using a bougie, allowing proper identification of the direction of esophageal descent through the hiatus, resulting in proper crural repair and the formation of an ideal wrap with a low-risk of prolonged dysphagia.

PDF Share
  1. DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 1986;204(1):9–20. DOI: 10.1097/00000658-198607000-00002.
  2. Low DE. Management of the problem patient after antireflux surgery. Gastroenterol Clin North Am 1994;23(2):371–389. PMID: 8070917.
  3. Gott JP, Polk HC. Repeat operation for failure of antireflux procedures. Surg Clin North Am 1991;71(1):13–32. DOI: 10.1016/s0039-6109(16) 45330-2.
  4. Anvari M, Allen CJ. Prospective evaluation of dysphagia before and after laparoscopic Nissen fundoplication without routine division of short gastrics. Surg Laparosc Endosc 1996;6(6):424–429. PMID: 8948032.
  5. Perdikis G, Hinder RA, Lund RJ, et al. Laparoscopic Nissen fundoplication: where do we stand? Surg Laparosc Endosc 1997;7(1):17–21. PMID: 9116940.
  6. Watson DI, Jamieson GG, Mitchell PC, et al. Stenosis of the esophageal hiatus following laparoscopic fundoplication. Arch Surg 1995;130(9):1014–1016. DOI: 10.1001/archsurg.1995.01430090100029.
  7. Watson DI, Pike GK, Baigrie RJ, et al. Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 1997;226(5):642–652. DOI: 10.1097/00000658-199711000-00009.
  8. Richardson WS, Hunter JG. Laparoscopic floppy Nissen fundoplication. Am J Surg 1999;177(2):155–157. DOI: 10.1016/s0002-9610(98) 00324-9.
  9. Velanovich V. The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 2007;20(2):130–134. DOI: 10.1111/j.1442-2050.2007.00658.x.
  10. Hunter JG, Trus TL, Branum GD, et al. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 1996;223(6):673–685; Discussion 685–687. DOI: 10.1097/00000658-199606000-00006.
  11. Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol 1986;8(Suppl 1):52–58. DOI: 10.1097/00004836-198606001-00008.
  12. Saeed ZA, Winchester CB, Ferro PS, et al. Prospective randomized comparison of polyvinyl bougies and through-the-scope balloons for dilation of peptic strictures of the esophagus. Gastrointest Endosc 1995;41(3):189–195. DOI: 10.1016/s0016-5107(95)70336-5.
  13. Hunter JG, Swanstrom L, Waring JP. Dysphagia after laparoscopic antireflux surgery. The impact of operative technique. Ann Surg 1996;224(1):51–57. DOI: 10.1097/00000658-199607000-00008.
  14. Nikolic M, Schwameis K, Semmler G, et al. Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication. Surg Endosc 2019;33(4):1196–1205. DOI: 10.1007/s00464-018-6396-5.
  15. Schietroma M, De Vita F, Carlei F, et al. Laparoscopic floppy Nissen fundoplication: 11-year follow-up. Surg Laparosc Endosc Percutan Tech 2013;23(3):281–285. DOI: 10.1097/SLE.0b013e31828e3954.
  16. Bonadiman A, Teixeira ACP, Goldenberg A, et al. Dysphagia after laparoscopic total fundoplication: anterior or posterior gastric wall fundoplication? Arq Gastroenterol 2014;51(2):113–117. DOI: 10.1590/s0004-28032014000200008.
  17. Wang B, Zhang W, Liu S, et al. A Chinese randomized prospective trial of floppy Nissen and Toupet fundoplication for gastroesophageal disease. Int J Surg 2015;23(Pt A):35–40. DOI: 10.1016/j.ijsu.2015.08.074.
  18. Migliore M, Deodato G. Clinical features and oesophageal motility in patients with tight fundoplication. Eur J Cardio-Thoracic Surg 1999;16(3):266–272. DOI: 10.1016/s1010-7940(99)00254-7.
  19. Lund RJ, Wetcher GJ, Raiser F, et al. Laparoscopic Toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility. J Gastrointest Surg 1997;1(4):301–308; Discussion 308. DOI: 10.1016/s1091-255x(97)80049-2.
  20. Yang H, Watson DI, Lally CJ, et al. Randomized trial of division versus nondivision of the short gastric vessels during laparoscopic Nissen fundoplication: 10-year outcomes. Ann Surg 2008;247(1):38–42. DOI: 10.1097/SLA.0b013e31814a693e.
  21. O'Boyle CJ, Watson DI, Jamieson GG, et al. Division of short gastric vessels at laparoscopic nissen fundoplication: a prospective double-blind randomized trial with 5-year follow-up. Ann Surg 2002;235(2):165–170. DOI: 10.1097/00000658-200202000-00001.
  22. Somasekar K, Morris-Stiff G, Al-Madfai H, et al. Is a bougie required for the performance of the fundal wrap during laparoscopic Nissen fundoplication? Surg Endosc 2010;24(2):390–394. DOI: 10.1007/s00464-009-0592-2.
  23. Stefanidis D, Hope WW, Kohn GP, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 2010;24(1):2647–2669. DOI: 10.1007/s00464-010-1267-8.
  24. Patterson EJ, Herron DM, Hansen PD, et al. Effect of an esophageal bougie on the incidence of dysphagia following nissen fundoplication: a prospective, blinded, randomized clinical trial. Arch Surg 2000;135(9):1055–1061; Discussion 1061–1062.
  25. Ng A, Yong D, Hazebroek E, et al. Omission of the calibration bougie in laparoscopic repair of paraesophageal hernia. Surg Endosc 2009;23(11):2505–2508. DOI: 10.1007/s00464-009-0426-2.
  26. Balsara KP, Shah CR, Hussain M. Laparoscopic fundoplication for gastro-esophageal reflux disease: An 8 year experience. J Minim Access Surg 2008;4(4):99–103. DOI: 10.4103/0972-9941.45205.
  27. Richter JE. Gastroesophageal reflux disease treatment: side effects and complications of fundoplication. Clin Gastroenterol Hepatol 2013;11(5):465–471; Quiz e39. DOI: 10.1016/j.cgh.2012.12.006.
  28. Engström C, Jamieson GG, Devitt PG, et al. Meta-analysis of two randomized controlled trials to identify long-term symptoms after division of the short gastric vessels during Nissen fundoplication. Br J Surg 2011;98(8):1063–1067. DOI: 10.1002/bjs.7563.
  29. Hamdy E, El Nakeeb A, Hamed H, et al. Outcome of laparoscopic Nissen fundoplication for gastroesophageal reflux disease in non-responders to proton pump inhibitors. J Gastrointest Surg 2014;18(9):1557–1562. DOI: 10.1007/s11605-014-2584-3.
  30. Prassas D, Krieg A, Rolfs TM, et al. Long-term outcome of laparoscopic Nissen fundoplication in a regional hospital setting. Int J Surg 2017;46:75–78. DOI: 10.1016/j.ijsu.2017.08.580.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.