Ineffective Esophageal Motility (IEM) is often identified during preoperative evaluations for anti-reflux surgery (ARS). Concerns regarding postoperative dysphagia may lead to hesitancy in offering surgery to these patients. This study compares postoperative dysphagia rates and lower esophageal sphincter (LES) function in patients with IEM versus those with normal esophageal peristalsis (NIEM).

We conducted a retrospective review of patients who underwent high-resolution manometry and robotic ARS between March 2011 and January 2024. Patients were classified as NIEM or IEM based on manometry, with IEM sub-stratified into non-severe (NSIEM: ≥ 50% to < 70% ineffective swallows) and severe (SIEM: ≥ 70% ineffective swallows). Postoperative dysphagia rates were assessed at 3, 6, and 12 months. LES function was evaluated using endoscopic impedance planimetry (Endo FLIP). Patients requiring reoperation were excluded.

A total of 633 patients met inclusion criteria: IEM (n = 97) and NIEM (n = 536). IEM patients were more likely to be male (p < 0.001) and less likely to be Hispanic (p < 0.001). Dysphagia rates did not differ significantly between groups at any time point. Subgroup analysis of NIEM, NSIEM, and SIEM revealed a significant difference in mild dysphagia at 12 months (p = 0.041), associated with preoperative dysphagia. However, the incidence of new-onset dysphagia at 12 months was not impacted by IEM. Preoperatively, IEM patients had larger LES cross-sectional areas (93.46 ± 43.32 vs. 76.7 ± 41.36 mm2, p = 0.009), higher pressure (25.49 ± 35.89 vs. 23.97 ± 8.26 mmHg, p = 0.009), and greater distensibility indices (4.78 ± 2.53 vs. 3.63 ± 2.42 mm2/mmHg, p < 0.001). Post-repair, IEM patients showed greater reductions in CSA and distensibility index compared to NIEM patients.

Patients with IEM had positive outcomes after ARS, with no significant differences in overall dysphagia rates compared to NIEM. Although mild long-term dysphagia was more common in IEM patients, it appears that these symptoms persist from before the surgery, suggesting that these patients tend to have similar long-term outcomes to patients without IEM.