Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, K-836, New York, NY, 10065, USA.
Department of Digestive and Endocrine Surgery, Orleans University Hospital Center, 14 Avenue de L'hopital, 45067, Orleans, France.
Surg Endosc. 2024 Oct;38(10):5623-5633. doi: 10.1007/s00464-024-11101-5. Epub 2024 Aug 5.
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.
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.
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) mm vs 66 IQR (42-93) mm, p = 0.02], and distensibility index (DI) [4.2 IQR (2.2-5.5) mm/mmHg vs 2.9 IQR (1.6-4.6) mm/mmHg, p = 0.003] compared to patients without post-operative dysphagia. Additionally, the decrease in CSA [- 34 (- 18.5, - 74.5) mm vs - 26.5 (- 10.5, - 53.7) mm, p = 0.03] and DI [- 2.3 (- 1.2, - 3.7) mm/mmHg vs - 1.6 (- 0.7, - 3.3) mm/mmHg, p = 0.03] measurements were greater in patients with post-operative dysphagia.
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.
抗反流手术后（ARS）出现吞咽困难是再次手术的最常见指征之一，也是导致患者不满的主要原因。不幸的是，其发展的影响因素尚未完全了解。我们研究了术前测压和术中阻抗平面测量（EndoFLIP™）与术后吞咽困难发展之间的相关性。
回顾了在我院接受指数机器人 ARS 的患者。我们的研究包括接受术前测压和术中 EndoFLIP™的患者。术前和术后 3 个月评估吞咽困难。
55 名患者（26.9%）报告术后出现吞咽困难，34 名患者（16.6%）报告出现新的或加重的吞咽困难。在术前测压中，术后出现吞咽困难的患者远端收缩积分较低[868.7（IQR 402.2-1447）mmHg s cm 与 1207（IQR 612.1-2111）mmHg s cm，p=0.006）和较低的食管下括约肌（LES）压力[14.7 IQR（8.9-23.6）mmHg 与 20.7 IQR（10.2-32.6）mmHg，p=0.01]与术后无吞咽困难的患者相比。他们还发现术前的横截面积（CSA）较高[83 IQR（44.5-112）mm 与 66 IQR（42-93）mm，p=0.02]和扩张指数（DI）较高[4.2 IQR（2.2-5.5）mm/mmHg 与 2.9 IQR（1.6-4.6）mm/mmHg，p=0.003]与术后无吞咽困难的患者相比。此外，术后 CSA 减少[-34（-18.5，-74.5）mm 与 -26.5（-10.5，-53.7）mm，p=0.03]和 DI 减少[-2.3（-1.2，-3.7）mm/mmHg 与 -1.6（-0.7，-3.3）mm/mmHg，p=0.03]在术后出现吞咽困难的患者中更为明显。
术后出现吞咽困难的患者术前运动功能较差，术中 LES 特征变化较大。这一发现表明术前测压和术中 EndoFLIP 可用于识别术后出现吞咽困难的风险患者。
