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Paper
May 1, 2008

Measuring the Effectiveness of Laparoscopic Antireflux Surgery: Long-term Results

Author Affiliations

Author Affiliations: Department of Surgery, Massachusetts General Hospital, Harvard Medical School (Drs Gee and Rattner), and Boston University School of Medicine (Mr Andreoli), Boston.

Arch Surg. 2008;143(5):482-487. doi:10.1001/archsurg.143.5.482
Abstract

Objective  To evaluate long-term results and quality of life of patients undergoing laparoscopic antireflux surgery.

Design  A validated survey instrument, the Gastroesophageal Reflux Disease–Health-Related Quality-of-Life Scale (GERD-HRQL) was mailed to all patients who underwent laparoscopic fundoplications (LFs) from 1997 to 2006. Additional information was obtained regarding reintervention, satisfaction, and medication use.

Setting  Tertiary care referral center.

Patients  Four hundred five consecutive patients who underwent primary or redo LF from 1997 to 2006.

Main Outcome Measures  GERD-HRQL score, reoperation rate, and antireflux medication use.

Results  A 54% response rate was obtained. Median follow-up was 60 months (range, 4-75 months). In patients who underwent primary LF, the mean (SD) GERD-HRQL score was 5.71 (7.99) (range, 0-45, with 0 representing no symptoms). Seventy-one percent of patients were satisfied with long-term results. Forty-three percent of patients took antireflux medications at some point following surgery; half of these patients had no diagnostic testing to document GERD recurrence. Only 3 patients (1.2%) required reoperation. Patients undergoing redo LF had higher GERD-HRQL scores (mean [SD], 14.25 [10.33]), lower satisfaction (35%), and greater probability of requiring antireflux medication (78%). Patients with body mass indexes (BMIs) (calculated as weight in kilograms divided by height in meters squared) between 25 and 35 had lower GERD-HRQL scores than thin (BMI < 25) and morbidly obese (BMI ≥ 35) patients.

Conclusions  Contrary to the medical literature, our results demonstrate that patients undergoing primary LF by an experienced surgical team have near-normal GERD-HRQL scores at long-term follow-up and low reoperation rates and are satisfied with their decision to undergo surgery. Results following redo LF are not as good, highlighting the importance of proper patient selection and surgical technique when performing primary LF.

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