Patient-reported Outcomes In 512 Patients After Laparoscopic Fundoplication Over Ten Years
*Hoover Wu1, *Michelle Campbell1, *Julia R Amundson1, *Vanessa VanDruff1, *Kristine Kuchta2, Herbert M Hedberg3, Michael B Ujiki3
1University of Chicago, Chicago, IL;2NorthShore University Research Institute, Evanston, IL;3NorthShore University Health System, Evanston, IL
Introduction:Laparoscopic fundoplication (LF) is the gold-standard surgical management for Gastroesophageal Reflux Disease (GERD). Optimal patient outcomes include resolution of symptoms with minimal postoperative side effects of dysphagia or gas-bloat. This study aims to review long-term outcomes in a single institution from two to ten years after surgery. Methods and Procedures:This is a retrospective review of a prospectively maintained quality database. Patients who underwent LF from 2009-2019 were included. Patient-reported outcome scores (PRO) include Reflux Symptom Index (RSI), GERD-Health Related Quality of Life (GERD-HRQL), and Dysphagia score. Comparisons were made using two-tailed Wilcoxon rank-sum tests, with statistical significance set at p<0.05. Results:Five hundred twelve patients had LF (Nissen N=353, Toupet N=159). Improvement in PRO did not worsen from two to ten years after surgery (Figure 1). Long-term PRO was similar between Nissen and Toupet at two, five, and seven years, however, Toupet had a better RSI score at five years (4.1±5.9 versus 9.2±9.5, p=0.02). Paraesophageal hernia (PEH) was present in 68% of patients (Nissen N=241, Toupet N=108). Preoperative PRO in non-PEH includes worse RSI (19.5±10.8 versus 15.7±11.0, p=0.01) and GERD-HRQL (16.9±12.4 versus 12.4±10.1, p=0.02), although less dysphagia (1.1±0.5 versus 1.3±0.7, p=0.02) than the PEH group. Long-term PRO was similar between the two except for worse gas-bloat in non-PEH patients at two years (2.0±1.5 versus 1.5±1.4, p=0.03). There were no statistical differences in PRO for patients with esophageal dysmotility (N=103) regardless of fundoplication type (Toupet N=73, Nissen N=30). Endoscopy was performed in 9.6% (N=49) of patients at a median of sixteen months, with 1.4% of patients (N=7) having abnormal DeMeester Scores. Median (Q1-Q3) preoperative DeMeester Score of 31 (17-51) decreased to 5.2 (1.9-15.1) at postoperative evaluation. Conclusions: This single-institution study reports excellent long-term patient-reported outcomes after laparoscopic fundoplication that persist up to ten years.
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