436 Safety and Efficacy of Anti Reflux Surgery in Patients with Connective Tissue Disorders

Abstract Introduction GORD is very common in connective tissue disorders (CTDs). Many CTD patients have significant reflux and many are refractory to medical management. Due to ineffective oesophageal motility, there are concerns that these patients would experience postoperative dysphagia and poor outcomes. This study aims to identify the most suitable technique for control of acid reflux whilst avoiding dysphagia, collating data from smaller studies. Method 10 studies were included after literature search conducted in the PubMed database. Statistical analysis of outcomes between operative techniques was performed. Results 10 articles from 2006 to 2024 were analysed, with a total of 137 patients undergoing laparoscopic anti-reflux surgery. The commonest operation performed was partial fundoplication (68%) followed by 3600 fundoplication, RYGB and oesophagectomy. All studies reported favourable outcomes for anti-reflux surgery with fundoplication and RYGB in patients with connective tissue disorders. 87 % of patients undergoing fundoplication reported resolution of reflux symptoms. All RYGB patients reported symptom resolution. 28% of patients reported postoperative dysphagia with 33% in those undergoing RYGB, 24% in those undergoing fundoplication and 75% in those undergoing esophagectomy. Conclusions 28% of the patients had worsened dysphagia immediately after operation although many of them resolved over time. However, symptom resolution rate is high and 93% patients are satisfied at 5-year post-op. Despite a lack of conclusive data, a partial wrap appears to provide the lowest rates of postoperative dysphagia whilst maintaining effective resolution of reflux. Insufficient data currently exists to compare anterior and posterior partial wrap.