Effect of an Esophageal Bougie on the Incidence of Dysphagia Following Nissen Fundoplication

Abstract

Based on retrospective, uncontrolled studies, it has been claimed that Nissen fundoplication should be performed over an esophageal bougie to minimize postoperative dysphagia. We hypothesized that a surgeon experienced in laparoscopic fundoplication will have similar rates of postoperative dysphagia whether or not an esophageal bougie is used. Design: A patient and observer blinded, randomized, prospective clinical trial to assess the effect of intraoperative bougie use. Setting: A tertiary care teaching hospital that is a regional referral source for complex laparoscopic foregut surgical procedures. Patients: Three hundred thirty-six consecutive patients referred for laparoscopic fundoplication between March 1, 1996, and July 31, 1998, were evaluated for eligibility based on inclusion criteria and, if applicable, were offered randomization for fundoplication with or without a 56F bougie. One hundred seventy-one patients were enrolled in this study. Interventions: All patients underwent laparoscopic Nissen fundoplication, 81 with a bougie (hereafter referred to as the bougie group) and 90 without a bougie (hereafter referred to as the no bougie group). Main Outcome Measures: Dysphagia severity and frequency were assessed by a blinded observer using a standardized scoring system. Incidence of complications related to the use or absence of a bougie, operative times, and postsurgical recovery was also assessed.

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation

“…DeMeester et al 4 proposed the use of large tube (48-50FR) inside the esophagus for calibration of the fundoplication to prevent transitory dysphagia. These fi ndings were similar to the results of Patterson et al 29 . Some authors advocate no advantages by this routine technique 30 , emphasizing the risk for perforation and severe complications related to these tubes 29,31 .…”

“…These fi ndings were similar to the results of Patterson et al 29 . Some authors advocate no advantages by this routine technique 30 , emphasizing the risk for perforation and severe complications related to these tubes 29,31 . We do not use this tube, but we double-check the gastric fundus fl oppy anti-refl ux valve as described previously.…”

Evidence-Based Appraisal of Antireflux Fundoplication

“…111,112 Some authors, therefore, do not recommend its routine use. 113 Looking at the only available RCT, 72 it appears that routine use of a bougie significantly reduces the rate of severe postoperative dysphagia, as defined by the authors, by 13.7%, with a 1.2% risk of iatrogenic perforation (Table 10). On the other hand, if we look at something more clinically relevant, such as the rate of postoperative dilatation, the results were higher in the group treated by routine use of the bougie.…”

“…71 Concerning calibration of hiatoplasty and wrapping by means of an esophageal bougie, there was 1 trial from Portland, Oregon. 72 The details and results of these trials are shown in Table 10.…”

Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? Systematic review and meta-analysis

“…RCTs comparing total fundoplication with and without division of short gastric vessels can not show any statistically significant difference in the outcome dysphagia (11) . The use of intraesophageal bougies and the confection of a floppy and short valve seems to be effective in reduce dysphagia (8,26) , but there are not much trials with methodological quality to confirm theses hypothesis.…”