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DOI:10.2214/AJR.07.2582
AJR 2007; 189:1464-1468
© American Roentgen Ray Society

Clinical Observations

Secondary Achalasia and Other Esophageal Motility Disorders After Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease

Natasha E. Wehrli1, Marc S. Levine1, Stephen E. Rubesin1, David A. Katzka2 and Igor Laufer1

1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
2 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.

OBJECTIVE. The purpose of our investigation was to determine the frequency of secondary achalasia and other esophageal motility disorders revealed on barium studies after laparoscopic Nissen fundoplication and to present the clinical and radiographic findings in these patients.

CONCLUSION. Esophageal dysmotility was found in nine (7%) of 138 patients after laparoscopic Nissen fundoplication, including secondary achalasia in three (33%), diffuse esophageal spasm (DES) in two (22%), and a nonspecific esophageal motility disorder in four (44%). Our findings suggest that patients who undergo laparoscopic Nissen fundoplication for gastroesophageal reflux disease are at risk for the development of esophageal motility disorders, including secondary achalasia and DES. Careful evaluation of esophageal motility on postoperative barium studies may help to identify esophageal dysmotility and to differentiate this finding from structural complications of the wrap as a cause of refractory symptoms in these patients.

Keywords: achalasia • barium studies • dysphagia • esophageal motility disorders • gastroesophageal reflux disease • Nissen fundoplication • surgical complications


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