Laparoscopic anti-reflux surgery in connective tissue disorders: a review of clinical outcomes.

INTRODUCTION

Connective tissue disorders (CTDs) frequently cause severe oesophageal dysmotility and medically refractory gastro-oesophageal reflux disease (GERD). Laparoscopic anti-reflux surgery may offer symptom relief, but concerns remain regarding postoperative dysphagia in patients with ineffective or absent peristalsis. This review assesses outcomes of anti-reflux surgery in patients with CTD, focusing on reflux control, dysphagia and the impact of fundoplication type.

METHODS

A PubMed search identified English-language studies reporting outcomes of laparoscopic anti-reflux surgery in patients with CTD. Extracted variables included demographics, preoperative investigations, operative approach, complications and symptom outcomes.

FINDINGS: Nine studies reporting 129 laparoscopic procedures were included, 109 of which were fundoplications. Scleroderma represented 78% of CTD diagnoses. Partial fundoplication comprised 68% of operations. Reflux symptoms resolved in 87% of patients, and regurgitation improved in 74%. Among the 62 patients with reported data, postoperative dysphagia occurred in 24%, with higher rates in cohorts predominantly undergoing Nissen fundoplication. Studies favouring partial wraps generally demonstrated lower dysphagia rates and sustained symptomatic improvement. Overall complication rates were 12%, with no reported mortality. Limited data on robotic procedures suggested comparable safety.

CONCLUSIONS

Laparoscopic fundoplication is a safe and effective treatment for GERD in patients with CTD, achieving 74%-87% resolution of presenting symptoms balanced against 24% postoperative dysphagia in the early postoperative period. Overall, 93% of patients were satisfied at 5 years post-surgery. Despite a lack of conclusive data, partial wraps appear to provide the lowest rates of postoperative dysphagia while maintaining effective resolution of reflux. Insufficient data currently exists to compare anterior and posterior partial wraps.