CHICAGO -- May 19, 2008 -- Patients undergoing laparoscopic anti-reflux surgery by experienced surgeons appear to be satisfied with their decision to undergo surgery and have low re-operation rates, according to a report in the May issue of Archives of Surgery.
Denise W. Gee, MD, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, and colleagues studied 191 patients who underwent primary or revision (re-do) laparoscopic anti-reflux surgery by a single surgeon from 1997 to 2006.
Surveys were mailed to participants to evaluate their symptoms on the gastroesophageal reflux disease (GERD)-Health-Related Quality of Life Scale (HRQL), which has a score of 0 to 45 (with 0 representing no symptoms). Use of postoperative anti-reflux medication, the need for postoperative intervention, patient satisfaction, and patient willingness to have the operation again were also assessed.
Participants had an average age of 52 years; 60% of the participants were women and 40% were men. The median duration of follow-up was 60 months. Of all 191 participants, 173 patients had primary anti-reflux surgery, and 18 patients had re-do anti-reflux surgery.
The average GERD score for those patients undergoing primary anti-reflux surgery was lower than that of patients who had re-do anti-reflux surgery (5.71 vs 14.25 after surgery).
The researchers found that 71% of patients who underwent primary anti-reflux surgery were satisfied with long-term results, and only 35% of the patients who underwent re-do anti-reflux surgery reported being satisfied. The majority of patients -- 88% who underwent primary anti-reflux surgery and 76% who had re-do anti-reflux surgery -- stated they would be willing to have the surgery again.
In addition, only 3 patients (1.2%) required re-operation, and patients with body mass indexes between 25 and 35 had lower GERD-HRQL scores than patients who were thin and morbidly obese.
"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," concluded the authors.
"In addition, [body mass index] appears to be an important factor when predicting long-term outcomes. Results following re-do laparoscopic fundoplication are not as good, highlighting the importance of proper patient selection and surgical technique when performing primary laparoscopic fundoplication."
SOURCE: Archives of Surgery
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