A team from Pittsburgh, Pennsylvania, USA, compared quality of life (QOL) after antireflux surgery with nonoperative management for severe gastroesophageal disease (GERD).
Some 171 patients undergoing surgical or medical treatment for GERD over a 1-year period were included in the retrospective analysis.
QOL was measured using the Short-Form 36, and heartburn severity was measured using the Health Related Quality of Life scale (a disease-specific instrument with a best score of 0 and a worst score of 45).
Laparoscopic fundoplication was undertaken in 120 patients with a median age of 47 years (range 17 to 80 years).
The medical cohort included 51 patients selected from the gastroenterology clinic with a median age of 48 years (range 17 to 82 years).
Duration of heartburn was not found to be significantly different, with 78% of the medical and 82% of the surgical patients having had symptoms for longer than 12 months.
There were no operative deaths. However, there were 12 complications (1 esophageal perforation, 2 pneumothorax, 1 pneumonia, 3 pulmonary embolus, 5 other).
Mean length of stay was 1.6 days, time to oral intake 1.2 days, and return to normal activity 4.2 weeks.
| QOL and satisfaction greater in the surgery group.
| Journal of the American College of Surgeons |
Routine follow-up was available in 118 surgical and 47 medical patients.
The researchers found that the medical cohort had increased symptoms of heartburn (43% versus 19%), waterbrash (26% versus 8%), and regurgitation (30% versus 8%) over the surgical group. Furthermore, they had greater requirement for proton pump inhibitors (74% versus 19%) and propulsid (19% versus 3%).
Detailed outcomes were available in 101 surgical and 37 medical patients.
Mean Health Related QOL scores were better in the surgical group (4 versus 21).
More of the medical patients were found to be dissatisfied (22% versus 6%).
Short-Form 36 scores at follow-up were better in 6 of 8 domains for surgical patients.
Hiran C. Fernando, of the Minimally Invasive Surgery Center at the University of Pittsburgh Medical Center, said on behalf of fellow authors, "Heartburn scores and global QOL scores were superior after laparoscopic fundoplication compared with medical management in this patient population.
"Laparoscopic fundoplication should be considered for patients who are dissatisfied with medical treatment," it was concluded.