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Postoperative symptoms and failure after antireflux surgery
Yashodhan S Khajanchee1, Robert W O'Rourke, Barbara Lockhart
1Department of Minimally Invasive Surgery, Legacy Health System, 501 N Graham, Suite 120, Portland, OR 97227, USA. lswanstr@lhs.org
Archives of Surgery (Chicago, Ill. : 1960)
|September 7, 2002
Summary
Postoperative symptoms after antireflux surgery poorly correlate with objective reflux measurements. Objective testing, not symptoms, should guide treatment decisions for gastroesophageal reflux disease.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Esophageal Physiology
Background:
- Symptomatic assessment is the primary method for evaluating outcomes after gastroesophageal reflux disease surgery.
- Objective testing is typically reserved for patients with persistent symptoms.
Purpose of the Study:
- To determine the relationship between subjective symptoms and objective outcomes following antireflux surgery.
- To assess the validity of symptomatic assessment in predicting objective reflux control post-surgery.
Main Methods:
- Retrospective analysis of prospectively collected data from a tertiary care hospital.
- Included 209 patients undergoing Nissen or Toupet fundoplication, with pre- and post-operative symptomatic and objective testing.
- Twenty-four-hour pH monitoring (DeMeester score) served as the gold standard for objective reflux assessment.
Main Results:
- 83.3% of patients achieved normal DeMeester scores post-surgery (median 2.2).
- Among patients with postoperative reflux symptoms, 29.3% had abnormal DeMeester scores.
- 11.9% of asymptomatic patients exhibited abnormal DeMeester scores, indicating objective reflux.
Conclusions:
- A significant disconnect exists between patient-reported symptoms and objective measures of acid reflux post-antireflux surgery.
- Surgeons should exercise caution in defining success/failure rates based solely on symptoms.
- Objective testing is crucial for guiding postoperative management of gastroesophageal reflux disease, rather than routine medical therapy based on symptoms alone.