Psychological factors can affect end points of surgical treatment.
In this study, researchers evaluated the outcome of laparoscopic antireflux surgery (LARS) in patients with gastroesophageal reflux disease (GERD) who experience concomitant major depression. The team compared these patients to GERD patients who have no known comorbidity.
The research team’s findings are published in the January issue of Surgical Endoscopy.
The team selected 38 GERD patients with concomitant major depression (MD) to be included in this study. The patients included 24 women and 14 men, with a mean age of 51 years.
They also selected a comparison group of 38 control patients (non-MD), matched in terms of age, gender, and esophageal manometry findings.
|Postoperative comparisons found significant differences between the 2 groups for chest pain, bloating, and dysphagia.|
In each group, 23 patients underwent a Toupet fundoplication, and 15 a “floppy” Nissen fundoplication.
The team evaluated several factors before surgery, 3 months, and 1 year after. These included GERD symptoms, quality of life, lower esophageal sphincter pressure (LESP), and 24-hour pH monitoring (DeMeester score).
The team found that both before and after surgery, there were no significant differences between the 2 groups in terms of LESP and DeMeester score.
However, preoperative quality of life scores showed significant differences between the 2 groups. These scores improved significantly at 3 months and 1 year after surgery, in all patients.
When the team compared symptoms between the 2 groups before surgery, they found significant differences were found in the percentage of chest pain and bloating. These symptoms were more predominant and graded as much more severe among patients with MD.
In both groups, all the symptoms, except dysphagia, showed a significant improvement in severity.
When the team performed a postoperative comparison of both groups, they found that significant differences were still present in chest pain, bloating, and dysphagia.
Differences were also observed in patients with major depression, depending on the kind of wrap procedure (Nissen versus Toupet). Dysphagia (79% versus 21%) and chest pain (82% versus 18%) were much more predominant in patients who underwent “floppy” Nissen fundoplication.
Dr Kamolz’s team concluded, “Even if they are good surgical candidates from a physiologic point of view, GERD patients with concomitant major depression should be selected carefully”.
“In these patients, LARS can normalize physiologic data, but some patients have demonstrated less symptomatic relief, suffered from postoperative dysphagia, and showed less quality-of-life improvement.”
“Eventually, laparoscopic Toupet fundoplication used with these patients could result in a better subjective outcome.”