Laparoscopic Anti-Reflux Surgery as Primary Treatment for IEM due to GERD

Abstract

Ineffective esophageal motility (IEM) related to gastroesophageal reflux disease (GERD) presents unique treatment challenges. Our study evaluates symptom outcomes in patients with IEM due to GERD undergoing laparoscopic anti-reflux surgery (LARS) to determine the incidence of subjective symptomatic improvement and evidence of worsened dysphagia. Following institutional review board (IRB) approval, we retrospectively evaluated patients who underwent LARS for GERD who demonstrated IEM on pre-operative high-resolution manometry (HRM) based on the Chicago 3 classification and evaluated symptom resolution at post-operative visits. 29 patients with IEM underwent LARS with the most frequent presenting complaints being regurgitation (24/29, 83%) and dysphagia (21/29, 72%). In patients presenting with dysphagia, 70.8% reported resolution at the first post-operative visit. The mean rate of resolution of dysphagia and regurgitation by the last follow-up was 78% and 85.7%, respectively. Laparoscopic anti-reflux surgery for IEM due to GERD resulted in subjective improvement in presenting symptoms including dysphagia and regurgitation with minimal complications and no generation of new post-operative dysphagia.