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Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease

Long-term quality of life assessment and surgical outcome

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Abstract

Background

It is known that laparoscopic antireflux surgery (LARS) can achieve an excellent surgical outcome including quality of life improvement in patients with erosive gastroesophageal reflux disease (GERD; EGD-positive). Less is known about the long-term surgical outcome in GERD patients who have no evidence of esophagitis (EGD-negative) before surgery. The aim of this study was to evaluate the surgical outcome in a well-selected group of EGD-negative patients compared to that of EGD-positive patients.

Methods

From a large sample of more than 500 patients who underwent LARS, 89 EGD-negative patients (mean age, 51 ± 6 years; 56 males) were treated surgically because of persistent reflux-related symptoms despite medical therapy. In all cases, preoperative 24-h pH monitoring showed pathological values. To perform a comparative analysis, a matched sample of EGD-positive patients (mean age, 54 ± 10 years; 58 males) was selected from the database. Surgical outcome included for all patients objective data (e.g., manometry and pH data and endoscopy), quality of life evaluation [Gastrointestinal Quality of Life Index (GIQLI)] symptom evaluation, as well as patients’ satisfaction with surgery. The data of a complete 5-year follow-up are available.

Results

There were no significant differences in symptomatic improvement, percentage of persistent surgical side-effects, or objective parameters. In general, patients’ satisfaction with surgery was comparable in both groups: 95% rated long-term outcome as excellent or good and would undergo surgical treatment again if necessary, respectively. Quality of life improvement was significantly better (p < 0.05) in the EGD-negative group because of the fact that GIQLI was more impaired before surgery (preoperative GIQLI, 81.7 ± 11.6 points/EGD-negative vs 93.8 ± 10.3 points/EGD-positive). Five years after surgery, GIQLI in both groups (121.2 ± 8.5 for EGD-negative vs 120.9 ± 7.3 for EGD-positive) showed comparable values to healthy controls (122.6 ± 8.5).

Conclusion

We suggest that LARS is an excellent treatment option for well-selected patients with persistent GERD-related symptoms who have no endoscopic evidence of esophagitis.

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Authors and Affiliations

  1. Division of Clinical Psychology, Public Hospital of Zell am See, A-5700 Zell am See, Austria

    T. Kamolz

  2. Department of General Surgery, Public Hospital of Zell am See, A-5700 Zell am See, Austria

    F. A. Granderath, U. M. Schweiger & R. Pointner

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  1. T. Kamolz
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  2. F. A. Granderath
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  3. U. M. Schweiger
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  4. R. Pointner
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Correspondence to T. Kamolz.

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Kamolz, T., Granderath, F.A., Schweiger, U.M. et al. Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease. Surg Endosc 19, 494–500 (2005). https://doi.org/10.1007/s00464-003-9267-6

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