Long-term outcome of antireflux operations as well as pre- and postoperative parameters able to predict their clinical results are still controversial.
Dr Rocco Roberto Pidoto and colleagues from Italy evaluated long-term quality of life with open fundoplication for chronic GERD.
The team investigated pre- and early postoperative functional parameters possibly related to persistence or recurrence of symptoms.
The investigators reviewed 25 patients who underwent open Nissen fundoplications for GERD with an average follow-up of more than 10 years.
Clinical evaluation was performed by using a symptom-specific score.
The team used 3 health-related quality of life scores, including a GERD-specific health related quality of life score.
In addition, 2 generic scores, such as the Short Form-36, were used to evaluate physical and psychological well-being.
| Recurrence of GERD-specific symptoms were reported by 32% of patients|
|American Journal of Surgery|
Subjective satisfaction grade of the patients was also investigated.
A univariate analysis was undertaken, according to the long-term presence or absence of residual symptoms.
The investigators took into account pre- and postoperative data of endoscopy, 24-hour pH monitoring, stationary manometry, and gastric-emptying tests.
The team found that persistence or recurrence of GERD-specific symptoms were reported by 32% of patients.
About 8% of patients were reoperated on for persistent dysphagia, whereas 68% were asymptomatic.
The GERD-health related quality of life and Short Form-36 scores displayed significant postoperative improvement, which continued in long-term follow-up.
The investigative team observed that 80% of patients had repeat fundoplication.
Among tested parameters, only postoperative mean supine esophageal clearance and gastric emptying half-time improved after the antireflux procedure.
However, these parameters differed significantly in long-term asymptomatic and symptomatic subgroups.
In long-term asymptomatic patients, the team noted that postoperative mean supine esophageal clearance was 0.8 minutes.
In symptomatic patients, the mean supine esophageal clearance rate was 2 minutes.
The investigators found that postoperative mean gastric emptying half-time of long-term asymptomatic patients was 93 minutes.
However, in symptomatic patients it was 128 minutes.
Dr Pidoto'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.”
“Also, gastric emptying could be regarded as an early postoperative predictor of long-term clinical outcome.”