Success of GERD surgery is independent of approach

The long-term quality of life after Nissen fundoplication is independent of surgical approach; most patients are satisfied if surgery decreases reflux symptoms and the need for acid suppression medication. Symptom relief and use of acid suppression medication after surgery to treat gastroesophageal reflux disease (GERD) determine improvements in quality life and patient satisfaction. In an outcomes survey, those patients who underwent transthoracic procedures tended to have better results, based on these two measures. Researchers at the University of Southern California, Los Angeles, sent a questionnaire to 348 patients after surgery. There were 105 responses; 72 patients had a laparoscopic Nissen fun-doplication, and 33 had a transthoracic version of the same surgery. Our aim was to determine the importance of operative approach and elimination of reflux on quality of life. Follow-up was a median of 25 months in patients who underwent laparoscopic procedures and 31 months in those who had transthoracic surgery. There were no significant differences in patient satisfaction or quality of life based on surgical technique. In fact, 92 percent of the laparoscopic group and 97 percent of the transthoracic group reported satisfaction. Participants were similar in terms of age and gender. However, as expected, patients undergoing the transthoracic procedure had more advanced disease including hiatal hernia or Barrett’s esophagus, said by a research fellow in the department of cardiothoracic surgery at USC. GERD is common and varies from mild to severe cases. Regarding more advanced GERD, people with reflux have a decreased quality of life that is comparable with other chronic conditions, such as congestive heart failure. Researchers used a combination of the Medical Outcomes Study SF-36 Health Survey, a standard tool that assesses both physical and mental health, and questions devised at their institution. On some measures, such as physical and bodily pain, two groups were similar. Researchers also uncovered differences; for example, 40 percent of the transthoracic patients versus less than 10 percent of laparoscopic patients were able to perform regular work duties eight weeks after surgery.

Although patients in the transthoracic group had more advanced disease and a more invasive procedure, they had similar quality of life and similar overall satisfaction. One doctor and his associates concluded that their results support a continued use of transthoracic antireflux surgery in patients with advanced GERD.