BACKGROUND: Transient postoperative dysphagia is not uncommon after antireflux surgery and usually runs a self-limiting course. However, a subset of patients report long-term dysphagia. The purpose of this study was to determine the risk factors for persistent postoperative dysphagia at 1 year after surgery. METHODS: All patients who underwent antireflux surgery were entered into a prospectively maintained database. After obtaining institutional review board approval, the database was queried to identify patients who underwent primary antireflux surgery and were at least 1 year from surgery. Postoperative severity of dysphagia was evaluated using a standardized questionnaire (scale 0-3). Patients with scores of 2 or 3 were defined as having significant dysphagia. RESULTS: A total of 316 consecutive patients underwent primary antireflux surgery by a single surgeon. Of these, 219 patients had 1 year postoperative symptom data. Significant postoperative dysphagia at 1 year was reported by 19 (9.1%) patients. Thirty-eight patients (18.3%) required postoperative dilation for dysphagia. Multivariate logistic regression analysis identified preoperative dysphagia (odds ratio (OR), 4.4; 95% confidence interval (CI), 1.2-15.5; p = 0.023) and preoperative delayed esophageal transit by barium swallow (OR, 8.2; 95% CI, 1.6-42.2; p = 0.012) as risk factors for postoperative dysphagia. Female gender was a risk factor for requiring dilation during the early postoperative period (OR, 3.6; 95% CI, 1.3-10.2; p = 0.016). No correlations were found with preoperative manometry. There also was no correlation between a need for early dilation and persistent dysphagia at 1 year of follow-up (p = 0.109). CONCLUSIONS: Patients with preoperative dysphagia and delayed esophageal transit on preoperative contrast study were significantly more likely to report moderate to severe postoperative dysphagia 1 year after antireflux surgery. This study confirms that the manometric criteria used to define esophageal dysmotility are not reliable to identify patients at risk for postfundoplication dysphagia, and that there is need for standardization of contrast swallow assessment of esophageal function.
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机译：背景：术后反流性吞咽困难在抗反流手术后并不少见，并且通常具有自限性。但是，部分患者报告长期吞咽困难。这项研究的目的是确定术后1年后持续性吞咽困难的危险因素。方法：将所有接受抗反流手术的患者输入前瞻性维护的数据库。在获得机构审查委员会的批准后，查询该数据库以鉴定接受了一次抗反流手术且距手术至少1年的患者。吞咽困难的术后严重程度使用标准问卷进行评估（等级0-3）。得分为2或3的患者被定义为患有严重吞咽困难。结果：总共316名连续患者由一名外科医生进行了一次抗反流手术。其中，219例患者术后1年有症状数据。 19例（9.1％）患者报告术后1年严重吞咽困难。 38例（18.3％）患者因吞咽困难需要进行术后扩张。多元逻辑回归分析确定术前吞咽困难（优势比（OR），4.4; 95％置信区间（CI），1.2-15.5; p = 0.023）和术前钡餐吞咽食管延迟转移（OR，8.2; 95％CI，1.6 -42.2; p = 0.012）作为术后吞咽困难的危险因素。女性性别是术后早期需要扩张的危险因素（OR，3.6; 95％CI，1.3-10.2; p = 0.016）。术前测压没有发现相关性。在随访的1年中，早期扩张的需要与持续性吞咽困难之间也没有相关性（p = 0.109）。结论：术前对比研究显示，术前吞咽困难和食管传输延迟的患者在反流手术后1年的报告中，重度吞咽困难的可能性更高。这项研究证实，用于定义食管动力障碍的测压标准不能可靠地确定有胃底折叠后吞咽困难风险的患者，因此有必要标准化吞咽造影剂评估食管功能。
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