Poor Esophageal Motility: A Tailored Approach?

New onset dysphagia following antireflux surgery is among the most undesirable side effects of an otherwise excellent therapy. While its cause is multifactorial, insufficient circular muscle strength of the esophageal body, not powerful enough to force the bolus through the distal neo-high pressure zone, can be a component of the pathophysiology. The relative merits of “tailoring” the degree of fundoplication based upon esophageal body motility and/or other clinical features have been debated for decades. Herein we discuss the rationale for a tailored approach, its pros and cons and review data published to date available to guide the clinician in individual patient decision-making.