Clinical surgery-International
Association between persistent symptoms and long-term quality of life after laparoscopic total fundoplication

https://doi.org/10.1016/j.amjsurg.2007.09.038Get rights and content

Abstract

Background

We investigated which factors are significantly associated with long-term quality of life after laparoscopic total fundoplication in the treatment of gastroesophageal reflux disease.

Methods

Patients (n = 144) were given a standardized frequency-intensity symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication.

Results

At follow-up evaluation (n = 102), patients had a significant reduction in their symptoms score and no deterioration in quality of life. A significant association with postoperative dysphagia for solids and/or liquids was found in the physical component summary score of the Short-Form 36 administered to patients postoperatively (P = .003).

Conclusions

In this study, laparoscopic total fundoplication was a safe and effective surgical treatment for gastroesophageal reflux disease, generally offering an improved long-term quality of life, with the exception of a minority of patients (6 of 102 patients; 5.8%) who experienced persistent severe dysphagia.

Section snippets

Materials and Methods

A total of 144 patients (78 males), with a mean age of 40.4 ± 15.1 years (range, 16–79 y) selected to undergo laparoscopic treatment for gastroesophageal reflux disease were included in the study after giving their informed consent. The study protocol was approved previously by the Ethical Committee of the Second University of Naples. All patients and controls were Caucasians from Italy.

Patients having typical or atypical symptoms for at least 6 months and requiring daily medical therapy for

Baseline

A total of 144 patients (78 males), with a mean age of 40.4 ± 15.1 years (range, 16–79 y) and with a mean duration of symptoms of 46.4 ± 47.3 months (range, 7–240 mo) before surgery, were enrolled in the study. All the patients survived. A conversion to an open procedure was required for respiratory troubles linked to pneumoperitoneum in 1 case (.7%). In 1 patient (.7%) an intraoperative mucosal tear occurred, which was repaired immediately by using 1 stitch and abdominal drainage, and no

Comments

The outcome of antireflux surgery traditionally has been evaluated by objective measurements (upper-gastrointestinal endoscopy, stationary esophageal manometry, and 24-hour ambulatory pH monitoring) that seem to have poor correlation with patient-perceived symptoms.16 From the patient's point of view, the so-called heuristic end points such as symptom resolution, patient satisfaction, patient well being, and quality of life are at least as important as objective tests, which are more invasive

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