Laparoscopy
Quality of life before and after laparoscopic fundoplication

Presented in part at the Seventh International Congress of the European Association for Endoscopic Surgery, Linz, Austria, June 1999.
https://doi.org/10.1016/S0002-9610(00)00415-3Get rights and content

Abstract

Background: Laparoscopic fundoplication is a well-established surgical option for the treatment of gastroesophageal reflux disease. The aim of this study was to assess the surgical outcomes from the patient’s point of view by using a validated quality of life instrument.

Methods: Fifty patients have been prospectively included. All patients underwent a standardized 270-degree posterior fundoplication. Quality of life was measured by the Gastrointestinal Quality of Life Index (GIQLI), a 36-item-questionnaire. The patients received the questionnaire before surgery, and 3 months and 1 year after surgery.

Results: Preoperative score was 95.6 ± 21 points. The score increased significantly (P <0.0005) at 3 months (103.6 ± 16) and 1 year (111.4 ± 22) after surgery. This improvement concerned the four domains of the questionnaire (symptoms, social functioning, physical status, and emotions). The score in patients at 1 year remained, however, significantly lower than that in healthy persons (126 ± 18).

Conclusions: GIQLI is a sensitive tool to assess surgical outcomes after fundoplication. The quality of life after surgery did not reach the level of healthy population, not because of failure of surgery to treat GERD but probably because of functional dyspepsia that was present prior to surgery and did not change after fundoplication.

Section snippets

Methods

Fifty patients with typical GERD were included in a prospective study between January 1997 and January 1998. All patients underwent a medical history, physical examination, and a routine esophagogastroscopy. A pH monitoring was done only when there was an esophagitis of grade A or less according to the Los Angeles grading system.19 Patients with a proven GERD were considered for surgery if the symptoms recurred after medical treatment or persisted despite the treatment.

The operative technique

Evolution of the GIQLI score

All patients filled out and sent back the three successive forms (practicality of 100%). There were 30 men and 20 women with a mean age of 49.9 ± 11.2 years. Preoperative overall score was 95.6 ± 21 points. The mean score increased significantly 3 months after the fundoplication to 103.6 ± 16 and reached 111.4 ± 22 at 1 year (P <0.0005 for both comparisons). Figure 1 shows the evolution of GIQLI score.

Quality of life in patients versus healthy persons

The GIQLI-score at 1 year was significantly (P <0.0005) lower than the score calculated in

Comments

Several quality of life instruments can be used to assess fundoplication outcomes from the patient’s point of view,21 but none is recognized unanimously as the gold standard. Four categories of instruments are generally used: generic, disease specific, symptom severity, and system specific instruments. In the field of GERD, generic instruments such as the SF-36 or the PGWB have been used10, 11, 12 but their main drawback is their lack of specificity for GERD (no item related to reflux symptoms).

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