Nissen fundoplication in patients with gastroesophageal reflux disease and ineffective esophageal motility

In patients with gastroesophageal reflux disease (GERD) and ineffective esophageal motility (IEM) who have surgical indication, there is controversy regarding the fundoplication to be performed, since Nissen fundoplication (NF) could increase the risk of postoperative dysphagia. Furthermore, studies that have evaluated NF for the treatment of GERD in patients with IEM are scarce. The aim of this study is to analyze the results of NF in patients with GERD and IEM. A retrospective study is carried out, whose study population consisted of patients with GERD and IEM who underwent NF between 2017 and 2023. Patients younger than 18 years, with paraesophageal hernias (II-IV), reinterventions and those with a follow-up of less than one year are excluded. Twenty-seven patients met the selection criteria. There were no complications (infection, bleeding or perforation), reinterventions or readmissions during the first 30 postoperative days. Moreover, 22,2% (n=6) had self-limited dysphagia that resolved in less than 3 months and 14,8% (n=4) had gas-bloat syndrome that resolved in the first 6 months. After 6 months, 18,5% (n=5) of the patients presented some degree of dysphagia, whose causes were: hiatal hernia in 3 cases, stenosis of the NF in one case and functional in another case. NF stenosis was resolved with endoscopic dilatations. After a mean follow-up of 53,1 ± 22,8 months, 22,2% (n=6) presented recurrence of GERD.