Quality of life after primary antireflux surgery: an analysis by primary indication

Antireflux surgery (ARS) includes all procedures performed at the hiatus, even those for indications other than typical gastroesophageal reflux disease (GERD). However, postoperative quality of life (QoL) across different indications remains poorly explored. We explored one-year QoL outcomes using the GERD-Health-Related Quality of Life (HRQL) instrument across four common indications and further described the trends over 5 years.

After IRB approval, we retrospectively queried data from a prospectively maintained database of patients who underwent elective minimally invasive ARS by a single surgeon (November 2017-August 2023). Patients were included if they completed both a preoperative and 1-year postoperative GERD-HRQL questionnaire. Exclusion criteria were revisional surgeries, non-fundoplication procedures, emergencies, and lung transplantation. We analyzed one-year GERD-HRQL total and subcomponent scores (heartburn, dysphagia, regurgitation) and patient satisfaction by surgical indication: (i) volume reflux/typical GERD, (ii) obstructive symptoms/dysphagia, (iii) chronic bleeding/anemia, and (iv) atypical GERD. Further, QoL trends and acid suppression therapy use were analyzed over five years among the entire cohort.

A total of 83 patients were included. The proportion of eligible patients at 1, 2, 3, and 5 years was 83/83 (100%), 31/55 (56.4%), 24/43 (55.8%), and 16/26 (61.5%), respectively. The median total GERD-HRQL score of the entire cohort improved from 27 (IQR: 12.5-40.5) preoperatively to 0 (IQR: 0-4.5), 2 (IQR: 0-10.5), 3.5 (IQR: 2-12), and 1 (IQR: 0.75-4.5) at 1, 2, 3, and 5 years, respectively (all p < 0.05). At one year in the atypical GERD group, HRQL scores trended higher (i.e., worse QoL) and satisfaction trended lower.

Although ARS improves QoL and patient satisfaction over time, current practice and research lack a stratified approach based on surgical indications and patient needs. Defining clear patient phenotypes and establishing specific surgical and patient-centered outcomes for each group should be the next priority.