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 26 May 2018

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Satisfactory quality of life with Nissen fundoplication in GERD

Nissen fundoplication improves long-term quality of life, and early postoperative esophageal clearance as well as gastric emptying are predictors of long-term clinical outcomes, reports March's American Journal of Surgery.

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Long-term outcome of antireflux operations as well as pre- and postoperative parameters able to predict their clinical results are still controversial.

Dr Andrea Cogliandolo and colleagues from Italy evaluated long-term quality of life with open fundoplication for chronic gastroesophageal disease (GERD).

The investigative team assessed pre- and early postoperative functional parameters possibly related to persistence or recurrence of symptoms.

The team reviewed a cohort of 25 patients who underwent open Nissen fundoplications at an average follow-up of more than 10 years.

Clinical evaluation was performed by using a symptom-specific score, and 3 health-related quality of life scores.

The health-related quality of life scores included a GERD-specific score, and 2 generic scores, the Short Form-36.

The scores evaluated physical and psychological well-being.

Subjective satisfaction grade of the patients was also investigated.

Postoperative gastric emptying half-time of long-term asymptomatic patients was 93 minutes
American Journal of Surgery

In addition, the investigators conducted a univariate analysis, according to the long-term presence or absence of residual symptoms.

The team took into account pre- and postoperative data of endoscopy, 24-hour pH monitoring, stationary manometry, and gastric-emptying test.

Persistence or recurrence of GERD-specific symptoms, such as heartburn and regurgitation were reported by 8 patients.

A further 2 patients were reoperated on for persistent dysphagia, whereas 17 patients were asymptomatic.

The GERD health-related quality of life and the Short-Form-36 scores displayed significant postoperative improvement, which continued in long-term follow-up.

The investigators found that 20 patients had repeat fundoplication.

Only postoperative mean supine esophageal clearance and gastric emptying half-time differed in long-term asymptomatic and symptomatic subgroups.

The team noted that in long-term asymptomatic patients, postoperative mean supine esophageal clearance was 0.8 and 2 minutes in symptomatic patients.

Postoperative mean gastric emptying half-time of long-term asymptomatic patients was 93 minutes.

The investigators observed that in symptomatic patients it was 128 minutes.

Dr Cogliandolo's team concluded, “Patients undergoing Nissen fundoplication had a satisfactory long-term quality of life.”

“Clinical results did not deteriorate over time and showed to be related to postoperative esophageal clearance and gastric emptying, which could be regarded as early postoperative predictors of long-term clinical outcome.”

Am J Surg 2006: 191(4): 470-8
16 March 2006

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