Fundoplication for gastro-oesophageal reflux.

Area of Science:

• Gastroenterology
• Surgical Oncology

Background:

• Severe gastro-oesophageal reflux disease (GERD) often necessitates surgical intervention.
• Fundoplication is a common surgical procedure for GERD, but its long-term outcomes and associated complications require ongoing evaluation.

Purpose of the Study:

• To assess the efficacy and patient satisfaction following fundoplication for severe GERD.
• To identify factors influencing outcomes and complications associated with the surgical procedure.

Main Methods:

• A retrospective study of 92 patients undergoing fundoplication between 1979 and 1984.
• Symptom severity was evaluated using a pre- and post-operative symptom score.
• Data on surgical technique variations (vagotomy, gastropexy, wrap position) and post-operative sequelae were collected.

Main Results:

• Fundoplication resulted in a significant reduction in symptom scores (mean 5.39 to 0.41), with 90.5% of patients experiencing absent or minimal symptoms.
• Overall patient satisfaction was 68%, with discrepancies attributed to sequelae such as gas bloat (19.6%), dumping (7.6%), and diarrhea (6.5%).
• Vagotomy did not improve results and increased complications; posterior gastropexy offered no benefit; intrathoracic fundoplication carried risks of perforation and ulceration.

Conclusions:

• Fundoplication is effective in symptom relief for severe GERD, but patient satisfaction is impacted by procedure-related morbidities.
• Avoiding vagotomy, minimizing wrap length, and reconsidering intrathoracic placement and gastropexy may improve functional outcomes and patient satisfaction.