Dysphagia after Hiatal Hernia Correction

The gastroesophageal reflux disease is chronic and common condition that affects about 10% of the population in general22 and corresponds to about 75% of esophageal disorders, with a progressive increase in incidence over the years18. Surgical treatment is permanent, in most cases, since the fundoplication restores the competence of the lower esophageal sphincter and the hiatoplasty reduces and treats the associated hiatal hernia. This is old procedure, firstly described in 1956 by Nissen through laparotomy and in 1991 by laparoscopy done by D’Allemagne. The laparoscopic surgical treatment proved to be better over the years for its significant improvement of postoperative pain, shorter hospital stay, faster return to activities and better aesthetic results4,8,13,30. Currently there is no doubt that surgical treatment of reflux disease by laparoscopy is safe and effective, with success rates above 85%2,6,7,11,12,17,21,26,28 being considered the “gold-standard” of laparoscopic surgery. However, some complications and failures have been reported in postoperatively3,9,16,23,24, among them the stenosis of the esophagogastric junction, dysphagia due to the very “tight” valve or fundoplication performed with the gastric body or its migration to the mediastinum. Additionally, recurrent gastroesophageal reflux valve migration resulting in total or partial dehiscence of suture may occur. However, not always these anatomic alterations produce symptoms of reflux disease20, but atypical ones. It is the aim of this study is to describe and report the diagnostic methods employed in the occurrence of persistent postoperative dysphagia after laparoscopic surgery for repair of hiatal hernia and reflux disease, as well as the therapeutic approach employed in these cases.