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Comparison of long term quality of life and patient satisfaction between Nissen and Toupet fundoplication

Amber L Shada, MD, Andrea M Stroud, MD, MS, Alexa K Statz, BS, Luke M Funk, MD, MPH, Sally Jolles, MA, Xing Wang, PhD, Daren C Jackson, PhD, Jacob A Greenberg, MD, EdM, Anne O Lidor, MD, MPH. University of Wisconsin

Introduction: Laparoscopic fundoplication is the gold standard treatment for gastroesophageal reflux disease (GERD) refractory to medical management. Although many studies have compared 360-degree (Nissen) fundoplication (NF) and posterior partial (Toupet) fundoplication (TF), it is unclear which surgery provides the best long-term reflux control. There is a paucity of long-term follow-up after fundoplication, particularly quality of life data. The objective of this study was to evaluate long-term patient-reported outcomes after fundoplication. We hypothesized that there would be similar satisfaction rates for TF and NF.

Methods and Procedures: Clinical data from our single academic institutional foregut database were used to identify patients who underwent NF or TF (June 2010 to November 2015). Electronic health record data was queried for patient demographics, comorbidities, diagnostic studies (EGD, barium swallow, manometry, impedance) and operative details. Post-operative quality of life (QoL) and symptoms were assessed via telephone at 1, 3, or 5 years post-surgery, using the GERD-Health-related Quality of Life, Gastroparesis Cardinal Symptom Index (GCSI) and Eckardt Dysphagia scores, use of proton-pump inhibitors (PPI) and satisfaction with surgery. Independent samples t-tests and chi-squares comparing TF and NF were used to examine group differences, while changes in outcome at 1, 3, and 5 years were assessed via one-way ANOVAs and planned pairwise comparisons.

Results: Our cohort included 140 TF and 142 NF patients. Phone follow-up response rate was 66% (range=56-83%). The majority of respondents were female (71.3%). The median follow-up interval was 39 months. Comparison of baseline demographics and diagnostic variables showed no clinically significant differences between groups at any time point. Mean esophageal amplitudes on manometry were 69mmHg for TF and 84mmHg for NF (p=0.023). There were no significant differences in GERD, GCSI, and Eckardt scores as well as satisfaction between TF and NF groups at 1, 3, or 5-year follow-up. PPI use increased over time in the TF group (p<0.001), but not in the NF group (p=0.86) and we noted a trend towards higher GERD scores between 1 to 5 years in the TF group (p=0.07). Table 1.

Conclusions: In our academic foregut practice, both TF and NF provide excellent long-term satisfaction for patients suffering from GERD. In contrast to previously published studies, our NF and TF patients reported similar QoL scores for GERD, GCSI and dysphagia. However, over time, we found increased PPI use and a trend towards worsening GERD scores with TF, suggesting that NF may be a more durable anti-reflux procedure.

*p-value from comparison of 1 and 5 years.  ^p-value from one-way chi square test. All between groups comparisons are nonsignificant.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80574

Program Number: S099

Presentation Session: Foregut 2

Presentation Type: Podium

326

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