Ajay H Bhandarwar, MS, Samarth S Agarwal, MS, Praveen N Tungenwar, MS, Amol N Wagh, MS, Saurabh S Gandhi, MS, Chintan B Patel, MS. Grant Government Medical College & Sir J.J.Group of Hospitals
Aim of this study is to establish responsiveness of quality of life SF-36 score and disease specific scores in GERD following Laparoscopic Nissen’s Fundoplication (LNF) with relation to oesophageal manometry and upper gastrointestinal endoscopy.
GERD is an emerging disease amongst the Asians with prevalence in India ranging from 8-20%. In India there is no such study showing effect of LNF on SF-36 score preoperatively and post operatively.
METHODS AND PROCEDURE:
An interventional prospective study was conducted in tertiary referral center in patients complaining of typical/atypical symptoms of GERD. Total 322 patients underwent LNF from 2008 to 2013. Ten patients were lost to follow-up and twelve (3.72%) patients were converted to conventional Nissen’s fundoplication. Hence total 300 patients were included. Of those 160 patients were male and 140 patients were female with mean age 38.7 ranging from 18-60 yrs.
1) Patient of age more than 18 years c/o symptoms of reflux and not completely eliminated by PPI’s.
2) Diagnosed cases of GERD and hiatal hernia with low PPI compliance.
3) Patients with well documented GERD who desire to stop chronic PPI therapy.
Patients with age below 18 years and pregnant patients.
Patients unfit for general anaesthesia.
Patients not willing to participate in the surgery.
After diagnosing, patients underwent LNF and follow up was done at 12 and 24 months after operation.
GERD score was calculated. Higher scores indicated more severe symptoms. Change in scores preoperatively and postoperatively >7 is significant.
SF36 is a well-validated score and measures 8 domains of life. These 8 domains can be summarized as a physical and mental health component score. A change of more than 5 scale points on any of 8 domains is clinically significant.
GERD Symptom SCORE: Paired t test used for calculation. Present study showed change in GERD score between pre-operative and post-operative 12 months is 14, as it is more than 7 and hence it is significant. However score was insignificant between preoperative and postoperative 12 to 24 months.
SF36 SCORE: All dimensions of quality of life score showed significant difference in pre operative and post operative 12 months with p value 0.003.
In a properly diagnosed PPI respondent patients , LNF has got improvement in GERD score and quality of life in all dimensions of SF-36 score.
Also LNF is an excellent surgical alternative for GERD patients for increasing LES pressure and decreasing oesophagitis.