Long-term evaluation of patients undergoing laparoscopic antireflux surgery without bougie placement.

BACKGROUND: Laparoscopic antireflux surgery (LARS) has replaced the open approach in most centers and has become the standard surgical treatment of this disease. One of the controversial technical issues is whether to use a bougie or not at the time of wrap. The aim of the study was to evaluate the long-term consequences of LARS in a series of patients without bougie.

METHODS: An institutional review board-approved study was conducted for patients who underwent LARS between 1998 and 2005. Patients were contacted and an SF-12 form was completed. Their charts were reviewed. Patient characteristics, preoperative evaluation, intraoperative details, and postoperative course were studied.

RESULTS: Overall, 135 patients were identified who underwent LARS from 1998 to 2005 with no bougie. Only 123 patients could be contacted for the study. Preoperative work-up included EGD in 100%, manometry in 98%, and 24-hour pH study in 25% of patients. Postoperative dysphagia to solids was seen in 11 of 123 (8.9%) patients. One patient (<1%) had dysphagia to liquids. Five patients (4%) had severe dysphagia. EGD and dilatation was required in 5 of 123 (4%) patients. Ten patients (8.1%) had recurrent reflux requiring medication. Also, 4 of 123 (3.2%) patients had bloating symptoms and 2 of 123 (1.6%) patients had difficulty vomiting. The mean follow-up of patients was 38.6 months.

CONCLUSIONS: The overall rate of dysphagia in this series following LARS without bougie was 8.9%. Mild to moderate dysphagia was seen in 6 of 123 (4.8%) and 4% patients had severe dysphagia requiring dilatation. Endoscopic dilatation was successful in relieving symptoms in patients with severe dysphagia. The incidence of severe dysphagia reported in the literature is 2-5% and recurrent reflux 5-15%. Rate of dysphagia was comparable to other series reported in the literature, as was the rate of recurrent reflux. Based on our series of patients, LARS without bougie appears to be effective in terms of postoperative dysphagia and recurrent reflux.