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Clinical effectiveness of laparoscopic fundoplication in a U.S. community
Nimish Vakil1, Michael Shaw, Russell Kirby
1Department of Medicine, Division of Gastroenterology, University of Wisconsin Medical School, Aurora Sinai Medical Center, Milwaukee, 53233, USA. nvakil@facstaff.wisc.edu
Background:
The aim of our study was to determine the outcome of laparoscopic fundoplication for reflux disease in a cohort of patients who underwent this procedure in routine clinical practice.
Methods:
We identified 151 patients who had undergone laparoscopic fundoplication in a managed care organization in Milwaukee. Symptoms were evaluated using a validated questionnaire. Postoperative medication use and endoscopic and surgical procedures were recorded.
Results:
Eighty-seven patients agreed to participate, of whom 80 (41 [51%] men) were eligible. Their mean (+/- SD) age was 45 +/- 12 years, and the mean duration after surgery was 20 +/- 10 months. Thirty-six patients (45%) underwent the procedure because their physician recommended it, and 22 (27%) because they thought it would cure their disease. Forty-three patients (61%) were satisfied with the outcome of the procedure. Twenty-six patients (32%) were taking medications on a regular basis for treatment of heartburn, 9 (11%) required esophageal dilation for dysphagia, and 6 (7%) had repeat surgical procedures. Of the 54 patients (67%) who reported new symptoms after surgery, 38 reported excessive gas, 22 reported abdominal bloating, and 22 reported dysphagia. Health-related quality of life was significantly lower in patients with these symptoms.
Conclusion:
Medical therapy is required for control of heartburn in approximately one third of patients after laparoscopic fundoplication. New symptoms are common after surgery. Patients need to be better informed about the indications and outcomes of surgery.