Introduction Laparoscopic Nissen’s fundoplication (LNF) is the procedure of choice in the surgical management of refractory gastroesophageal reflux disease (GORD). Few studies have reported subjective symptomatic outcome and objective investigative outcome postoperatively. The correlation between these two outcome measurements is unclear. The objective of this study is to evaluate a hundred consecutive LNFs in relation to patient’s anatomic and physiologic status after the procedure, patient’s functional outcome, and the rate and pattern of procedure failures.
Method Patients who underwent LNFs from 2007 to 2014 under a single surgeon were identified retrospectively. Patient demographics, morbidities, follow-up investigations and any redo operation were recorded. Surgical outcome was reported using the Viscik symptom evaluation tool. Patient telephone survey was performed using the validated GERD-HRQL (Health Related Quality of Life) questionnaire to assess patients’ functional outcome.
Results A total of 100 consecutive patients were identified in the 8 year period. Redo operations had been performed or planned for 11 of these patients. 30 patients underwent postoperative oesophagogastroduodenoscopy (OGD) and 29 patient were investigated with barium studies to evaluate the recurrence of symptoms. 37 patients have been contactable for telephone follow-up survey; 13 of the interviewed patients reported symptoms of gas bloat syndrome; 15 patients experienced a recurrence of their reflux symptoms, while 9 patients experienced a degree of regurgitation. 24 patients were satisfied with the operation, while 8 patients remained neutral.
Conclusion Postoperative symptomatic evaluation revealed a suboptimal subjective outcome that is inexplicable by the endoscopic/ radiological findings, suggesting the need for a standardised procedure-specific postoperative objective evaluation tool. The high incidence of post operative gas bloat syndrome suggests the need for routine pre-operative evaluation of gastric motility and tailoring the fundoplication accordingly. The higher than expected rate of anatomical failures highlighted the inadequacy of primary hiatorraphy, and the need for selective crural reinforcement.
Disclosure of interest None Declared.