Quality of life assessment after Nissen fundoplication

The aim of this study was to evaluate the quality of life of 31 patients presenting with gastroesophageal reflux (GORD) and operated on by Nissen fundoplication. The series consisted of 23 men and 8 women; the median age was 39 years (range 22-65) and the median follow-up 36 months (range 18-74). We used a new questionnaire: the Gastrointestinal Quality of Life Index (GIQLI) that includes 36 items and uses a five-graded Likert scale (from 0 to 4) giving a maximum score of 144. This score includes five dimensions: symptoms, emotions, vitality, social relations and medical treatment. The pre- and postoperative GIQLI scores observed in the Nissen group and the score of a control group of 110 healthy patients were compared with each other. The preoperative score (71 +/- 21) was greatly impaired compared to the score (123 +/- 13) of the control group (p < 0.0001). The postoperative score (109 +/- 21) increased significantly (p < 0.0001) but remained statistically inferior to the score of the control group (p < 0.005). The analysis of the dimensions showed that the postoperative score of the symptoms was lower in the Nissen group: 56 +/- 9 versus 66 +/- 6 in the control group (p < 0.0005) whereas no statistical difference was found for the four other dimensions. This lower symptoms score was not due to recurrence of GORD symptoms but to the occurrence of flatulence and to the persistence of gurgling noises and gas bloating. In conclusion, the quality of life of the patients requiring surgery for gastroesophageal reflux was greatly impaired, it largely improved after Nissen fundoplication but did not reach the level of healthy patients because of unrelated GORD gastrointestinal symptoms.