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 20 October 2017

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News

Risk factors for recurrence of GERD after laparoscopic antireflux surgery

This week's issue of the Journal of the American Medical Association examines the association between laparoscopic antireflux surgery and recurrence of gastroesophageal reflux.

News image

Cohort studies, mainly based on questionnaires and interviews, have reported high rates of reflux recurrence after antireflux surgery, which may have contributed to a decline in its use.

Reflux recurrence after laparoscopic antireflux surgery has not been assessed in a long-term population-based study of unselected patients.

Dr John Maret-Ouda and colleagues determined the risk of reflux recurrence after laparoscopic antireflux surgery, and identified risk factors for recurrence.

The team performed a nationwide population-based retrospective cohort study in Sweden between 2005 and 2014, based on all Swedish health care, and including 2655 patients who underwent laparoscopic antireflux surgery according to the Swedish Patient Registry.

The patients' records were linked to the Swedish Causes of Death Registry and Prescribed Drug Registry.

The team evaluated primary laparoscopic antireflux surgery due to gastroesophageal reflux disease in adults.
Risk factors for reflux recurrence included female sex, and comorbidity
Journal of the American Medical Association

The outcome was recurrence of reflux, defined as use of antireflux medication or secondary antireflux surgery.

Multivariable Cox regression was used to assess risk factors for reflux recurrence.

The team followed up all 2655 patients who underwent antireflux surgery for a almost 6 years.

The research team found that 470 patients had reflux recurrence, of which 393 received long-term antireflux medication, and 77 underwent secondary antireflux surgery. 

Risk factors for reflux recurrence included female sex, and comorbidity.

The team observed that hospital volume of antireflux surgery was not associated with risk of reflux recurrence.

Dr Maret-Ouda's team cocluded, "Among patients who underwent primary laparoscopic antireflux surgery, 18% experienced recurrent gastroesophageal reflux requiring long-term medication use or secondary antireflux surgery".

 "Risk factors for recurrence were older age, female sex, and comorbidity".

 "Laparoscopic antireflux surgery was associated with a relatively high rate of recurrent gastroesophageal reflux disease requiring treatment, diminishing some of the benefits of the operation."

JAMA 2017: 10: 939-946
21 September 2017

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