209 A Systematic Review and Meta-Analysis of Postoperative Outcomes of Anti-Reflux Surgery for GORD in Patients with Oesophageal Dysmotility

Abstract Background The consideration of anti-reflux surgery for patients of gastroesophageal reflux disease (GORD) with esophageal dysmotility (IEM) is still controversial. Our aim was to conduct a systematic review and meta-analysis to compare the outcomes of those With Preoperative Ineffective esophageal motility (IEM) versus Normal Motility(non-IEM) who underwent Anti-reflux surgery in patients with GORD. Method We conducted a systematic search of electronic information sources, including MEDLINE, EMBASE, CINAHL, CENTRAL, ClinicalTrials.gov, and bibliographic reference lists. We applied a combination of free text search and controlled vocabulary search adapted to thesaurus headings, search operators, and limits in each of the above-mentioned databases. New-onset postoperative dysphagia and persistent dysphagia were primary outcome parameters. Results We identified 3 randomized controlled trials and 17 observational study reporting a total of 3816 patients, of whom 849 have pre-op IEM and 2436 with normal motility, who had Nissen Fundoplication (NF). 198 patients with IEM and 154 with normal motility (non-IEM) patients underwent Toupet fundoplication (TP). New-onset postoperative dysphagia was less frequent in IEM group vs non-IEM (8.4% vs11.3%,P=0.09). persistent dysphagia was more common in IEM vs non-IEM (14.4%vs12.4%,P=0.4). There is significant reduction in heartburn symptoms in post vs pre-operative period without any statistically significant difference between the two cohorts (41%vs47%,p=0.79). A sensitivity analysis limited to NF recipients confirmed the same outcomes. Conclusions Anti-reflux surgery, including NF, appears to be a safe procedure for GORD patients with IEM, showing no significant increase in postoperative dysphagia compared with those who have normal motility.