Long-term outcomes of laparoscopic antireflux surgery

The short-term outcomes of laparoscopic antireflux surgery (LARS) in treatment of gastroesophageal reflux disease (GERD) are quite good, but some long-term studies have shown that the early good results are worsening with time.The aim of this study was to evaluate retrospectively, the long-term outcome of LARS with special attention to determinant factors.

From August 1994 (start of Mansoura program) to June 2004, 250 patients underwent LARS at the Mansoura gastroenterology surgical center, Mansoura University, Egypt. Preoperative symptoms and the results of esophageal functional studies as well as details of the operation and follow-up were recorded in a database. In 2009, 180 out of these 250 patients (72%) were contacted and reassessed with regard to their clinical outcome and patient satisfaction. There were no differences in presentation profiles of those patients contacted and those could not.

At a median follow-up of 70 months, individual symptoms, among those who had them preoperatively, were as follows: heartburn (175 patients) improved in 160 (91.4%) and resolved in 130 (74.3%), regurgitation (115) improved in 106 (92.2%) and resolved 93 (80.9%), dysphagia (65) improved in 45 (69.2%) and resolved in 37 (56.9%), cough (18) improved in 12 (66.7%) and resolved in 8 (44.4%), and hoarseness (10) improved in 7 (70%) and resolved in 4 (40%). Patient satisfaction was better among younger males with preoperative typical reflux symptoms (heartburn without dysphagia), respondents to medication and those had short floppy complete (Nissen) wrap (p < 0.05). Five patients (2.8%) developed a new onset of dysphagia, 16 patients (8.9%) developed new or increased diarrhea and 18 patients (10%) developed bloating postoperatively. Seventy patients (38.9%) were taking some form of antacid medication (20% prescripted and 18.9% nonprescripted) and 6 (3.3%) had undergone reoperation (2 for tight wrap and 4 for disrupted herniated wrap).

LARS provides effective long-term relief of GERD, however one-fifth of patients needs regular antacid medication. Younger males, typical reflux symptoms (heartburn without dysphagia) and preoperative response to medication are predictors of superior outcomes. Short floppy complete wrap is more durable than an incomplete one.