Pain after laparoscopic antireflux surgery.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Antireflux surgery provides established benefits for gastroesophageal reflux disease.
• Laparoscopic antireflux procedures are recognized for their general safety and efficacy.
• Understanding postoperative pain is crucial for patient outcomes after these minimally invasive surgeries.

Purpose of the Study:

• To systematically review the incidence, causes, and management of pain following laparoscopic antireflux surgery.
• To analyze pain frequency and characteristics based on available literature.
• To develop an investigative algorithm for persistent pain after laparoscopic fundoplication.

Main Methods:

• Systematic literature review using the PubMed database.
• Inclusion criteria: studies with ≥30 patients reporting pain after laparoscopic antireflux surgery.
• Exclusion criteria: pediatric cases, Collis gastroplasty, endoluminal fundoplication, paraesophageal hernia repair.

Main Results:

• Seventeen studies were included, reporting abdominal pain in 24.0% and chest pain in 19.5% of patients.
• The majority of pain was mild to moderate; severe pain occurred in 4% of patients.
• Pain frequency did not correlate with the specific type of laparoscopic antireflux operation performed.

Conclusions:

• Over 20% of patients experience pain post-laparoscopic antireflux surgery.
• While most pain is mild and manageable, a subset experiences severe, persistent, and potentially disabling pain.
• Systematic investigation is essential for diagnosing and treating difficult cases of post-fundoplication pain.