Esophagography Predicts Favorable Outcomes after Laparoscopic Nissen Fundoplication for Patients with Esophageal Dysmotility Matthew J D’Alessio, MD, Steven Rakita, MD, Mark Bloomston, MD, Christopher M Chambers, MD, Emmanuel E Zervos, MD, FACS, Steven B Goldin, MD, FACS, Jerry Poklepovic, MD, H Worth Boyce, MD, Alexander S Rosemurgy, MD, FACS BACKGROUND: We undertook this study to determine if clearance of a food bolus at preoperative esophagog- raphy predicts acceptable outcomes after laparoscopic Nissen fundoplication for patients with manometrically abnormal esophageal motility. STUDY DESIGN: Patients with gastroesophageal reflux disease (GERD) or symptomatic hiatal hernia with evi- dence of esophageal dysmotility by stationary manometry underwent videoesophagography to document the ability of their esophagus to clear food boluses of varying consistencies. Sixty-six patients were identified who had manometric dysmotility yet were able to clear a food bolus at esophagography, and subsequently underwent laparoscopic Nissen fundoplication. These pa- tients were compared with 100 randomly selected patients with normal motility who under- went laparoscopic Nissen fundoplication. Symptom reduction and satisfaction were assessed through followup. Patients with normal motility were compared with those with manometri- cally moderate and severe dysmotility. RESULTS: Preoperative patient demographic data, symptoms, and symptom scores were similar among patients with normal motility and moderate or severe dysmotility. After fundoplication, symp- tom reduction was notable for all patients regardless of preoperative motility (p  0.01, paired Student’s t-test). There was no notable difference in postoperative symptom scores (p = NS, Kruskal-Wallis ANOVA) or in patient satisfaction (p = NS, chi-square analysis) among patients stratified by esophageal motility. CONCLUSIONS: Patients with esophageal dysmotility documented by manometry who are able to clear a food bolus at contrast esophagography, have functional results after laparoscopic Nissen fundoplica- tion similar to patients with normal motility. Preoperative esophagography predicts successful outcomes after laparoscopic Nissen fundoplication for patients with manometric esophageal dysmotility. (J Am Coll Surg 2005;201:335–342. © 2005 by the American College of Surgeons) Esophageal dysmotility commonly occurs with gastro- esophageal reflux disease (GERD). In a study of more than 1,000 patients with GERD, 44% had an esopha- geal motility disorder. 1 Degree of esophageal dysmotility can correlate with the severity of GERD. 2,3 Although the association between GERD and esophageal dysmotility is clear, a cause-and-effect relationship is not obvious. And although pronounced dysmotility is a recognized cause of GERD, mechanisms by which GERD can promote esophageal dysmotility are unestablished. 4 Whether dys- motility is a result of acid in the esophageal lumen, the corresponding mucosal injury, or other causes, remains a point of speculation. Adding to the debate, medical con- trol of reflux symptoms has not been successful in restor- ing esophageal motility. 5,6 In contrast, several studies have shown that operative correction of GERD results in partial or even complete resolution of esophageal dysmotility. 3,7-10 This probably reflects the superior effi- cacy of reflux control through operative reconstruction Competing Interests Declared: None. Received April 16, 2004; Revised April 27, 2005; Accepted April 29, 2005. From the Departments of Surgery (D’Alessio, Rakita, Bloomston, Chambers, Zervos, Goldin, Boyce, Rosemurgy) and Radiology (Poklepovic), University of South Florida College of Medicine, Tampa, FL. Correspondence address: Alexander S Rosemurgy, MD, FACS, Department of Surgery, University of South Florida,Tampa General Hospital, PO Box 1289, Rm F-145, Tampa, FL 33601. 335 © 2005 by the American College of Surgeons ISSN 1072-7515/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jamcollsurg.2005.04.036