An article published in the May issue of Archives of Surgery finds that patients who receive the anti-reflux surgery – laparoscopic fundoplication – by experienced surgeons have low re-operation rates and report being satisfied satisfaction with the decision to have the surgery.
A minimally invasive procedure, laparoscopic fundoplication corrects gastroesophageal reflux disease, also know as GERD. GERD is a disorder in the digestive system characterized by food or liquid traveling from the stomach to the esophagus – resulting in irritation, heartburn, chest pain, and other symptoms. Though there currently exist reports that demonstrate the short-term effectiveness of laparoscopic anti-reflux surgery, studies on the long-term effectiveness have not been consistent.
To add to the literature on the longer-term effects of the procedure, Denise W. Gee, M.D. (Massachusetts General Hospital and Harvard Medical School, Boston) and colleagues analyzed 191 patients who, between 1997 and 2006, underwent primary or revision (redo) laparoscopic fundoplication by a single surgeon. Participants filled out a survey (administered by mail) that was primarily designed to collect data about their symptoms using the GERD-Health-Related Quality of Life Scale (GERD-HRQL). The GERD-HRQL is scored between zero and 45, where zero represents no symptoms. Data from the survey also provided information regarding the use of anti-reflux medication after surgery, the need for intervention after surgery, patient satisfaction, and the patient’s attitude towards having the operation again.
The survey participation rate was 54% (n = 191). Responders had an average age of 52 and 60% were female. “The median [midpoint] duration of follow-up was 60 months,” write the authors. Of the 191 respondents, 173 patients had primary anti-reflux surgery and 18 patients had redo anti-reflux surgery. For those who underwent primary anti-reflux surgery, the average GERD score was 5.71 after surgery; this was lower than the average score of 14.25 for those who had redo surgery.
Of the patients who underwent primary anti-reflux surgery, 71% reported being satisfied with long-term results and 88% said that they would be willing to have the surgery again. Only 35% of the patients who underwent redo surgery reported being satisfied, but 76% said that they would do it again.
In the authors’ words, “Only three patients (1.2 percent) required re-operation. Patients with body mass indexes (BMIs) between 25 and 35 had lower GERD-HRQL scores than thin and morbidly obese patients.”
“In contrast to reports in the medical literature, the results of this study demonstrate that most patients undergoing primary laparoscopic fundoplication by an experienced surgical team have near normal GERD?HRQL scores at long-term follow-up and low re-operation rates and are satisfied with their decision to undergo surgery. In addition, BMI appears to be an important factor when predicting long-term outcomes,” conclude the authors. “Results following redo laparoscopic fundoplication are not as good, highlighting the importance of proper patient selection and surgical technique when performing primary laparoscopic fundoplication.”
Measuring the Effectiveness of Laparoscopic Antireflux Surgery
Denise W. Gee, MD; Michael T. Andreoli, BA; David W. Rattner, MD
Archives of Surgery (2008). 143[5]:482-487.
Written by: Peter M Crosta