Laparoscopic Nissen fundoplication (LNF) is the procedure of choice in the surgical management of patients suffering from gastroesophageal reflux disease (GERD).
There is little data on assessment of long-term failures after LNF.
In this study, investigators from Ireland evaluated the mechanisms of failure in 131 patients who reported suboptimal results after LNF.
They also identified factors that might predispose GERD patients to anatomical or physiological failure.
There were 14 patients in the failure group.
The team found that a hiatus hernia greater than 3 cm, abnormal pH analysis, failure to respond to proton pump inhibition, and a psychiatric history were predictors of failure.
Dr Colm Power's team concluded, "In patients who do not respond to proton pump inhibition preoperatively, the evaluating surgeon should be circumspect in advocating antireflux surgery".
"A detailed assessment of underlying psychiatric or psychological symptoms must also be made".
"If a large (>3 cm approximately) hiatus hernia is identified or there is abnormal pH analysis in the upright position preoperatively, the surgeon should be guarded about the long-term outcome, and patients should be advised accordingly".