Beyond symptom improvement: a qualitative study of patient-defined treatment goals and surgical success after...

Gastro-esophageal reflux disease (GORD) has multifactorial effects that substantially impair quality of life. Anti-reflux surgery (ARS) is an established treatment for appropriately selected patients; however, current outcome reporting is largely symptom-focused and may not fully capture patient-derived goals and expectations that shape perceptions of surgical success. A qualitative study using semi-structured interviews and inductive thematic analysis was conducted in postoperative patients at a tertiary upper gastrointestinal surgical unit in Australia. Patient-identified experiences of GORD, expectations of surgery, and perceived determinants of surgical success were explored. Participants described GORD as a chronic condition with pervasive impacts on daily functioning and psychosocial wellbeing. Surgery was primarily motivated by the desire to restore everyday functioning, reduce medication reliance, and exclude serious pathology. Surgical success was evaluated according to multidimensional, patient-defined goals centered on functional improvement. Satisfaction depended on concordance between post-operative outcomes and preoperative expectations. Rather than pursuing complete symptom resolution, some patients may accept trade-offs to prioritize individual treatment goals. Dissatisfaction was commonly associated with new non-reflux symptoms, particularly when these caused unexpected functional limitations, despite effective reflux control. Patients evaluated satisfaction according to the extent to which postoperative outcomes aligned with patient-specific, function-focused treatment goals. A patient-centered approach to ARS should therefore include exploration of patients' motivations for surgery and goals to guide expectation setting and shared decision-making. Incorporating functional outcomes alongside conventional symptom measures may further improve the evaluation of surgical success.