On the whole, patients who undergo a laparoscopic fundoplication procedure should have objective evidence of gastroesophageal reflux.
However, occasionally patients without objective evidence of reflux disease are referred for surgery.
In this study, researchers from Australia assessed the outcome of a group of patients who underwent laparoscopic fundoplication. These patients had no objective evidence of reflux at either preoperative endoscopy or pH monitoring.
The research team collected their data prospectively, from patients who underwent laparoscopic fundoplication between 1991 and 2001.
From a total of 1003 patients, a subgroup of 15 patients was identified who had no evidence of ulcerative esophagitis at endoscopy or abnormal reflux on 24-h pH monitoring.
The team found that 8 of these patients had typical symptoms of reflux, and 7 had atypical symptoms such as cough, bloating, chest pain, or sore throat.
All patients had tried medication for acid suppression before surgery, with 5 gaining little or no benefit.
|Mean patient satisfaction score was 8.7 at 3 months and at 1 year, postoperatively.|
|Diseases of the Esophagus|
The mean acid exposure time was 2%.
The researchers identified a correlation between typical symptoms and reflux events of over 50% in 3 patients.
All patients underwent laparoscopic fundoplication, with 1 conversion to an open procedure.
The team found that the mean patient satisfaction score (0 to 10 linear score) was 8.7 at 3 months and at 1 year, postoperatively.
However, 3 patients failed to improve following surgery.
All 3 had atypical symptoms, a symptom correlation of less than 50% with acid reflux on pH monitoring, and 2 of the 3 had a poor response to medication.
All other patients benefited symptomatically from surgery.
Drs Leeder, Watson, and Jamieson concluded, "The absence of objective evidence of reflux should not always preclude patients from a laparoscopic fundoplication".
"Carefully selected patients with typical reflux symptoms can have a good outcome".
"However, patients who do not have typical symptoms and who respond poorly to acid suppression are not likely to benefit from surgery".