The High Resolution Esophageal Manometry and Predictors Parameters of Dysphagia in Post-Laparoscopic Hiatoplasty and Nissen Fundoplication - A Systematic Review

Background: Gastroesophageal reflux disease has a prevalence of 12% in the Brazilian population. Its treatment includes hygienic-dietary changes, use of medications and, in selected cases, surgery with laparoscopic hiatoplasty and Nissen total fundoplication. However, this last treatment modality presents risks of postoperative dysphagia. High Resolution Esophageal Manometry (HREM) has been considered the test of choice for identifying patients who are candidates for surgical treatment at an increased risk of developing dysphagia. Objective: The objective of this study is to carry out a systematic review to evaluate the clinical and manometric factors that predict post-hiatoplasty and Nissen fundoplication dysphagia using HREM. Methods and results: Having defined the search engine, we used the databases MEDLINE, PUBMED, EBSCOHOST, SCOPUS and EMBASE. 2147 articles were identified. After selection, 11 studies remained. Conclusion: We concluded that the data from the selected articles are heterogeneous, but there is agreement regarding a higher risk of dysphagia among female patients, patients with dysphagia present in the preoperative period and, about manometric parameters, for patients with dysphagia in the preoperative period, there is a higher incidence of dysphagia resolution for patients with DCI >1000 mmHg.s.cm. In patients with ineffective esophageal motility, it is recommended to perform the Rapid Multiple Swallowing Test to assess the contractile reserve of the esophageal body. If there is an increase in contractile strength with this test, it is considered safe to perform a total fundoplication because the incidence of late dysphagia is low in these cases.