Zia Kanani1, Melissa Helm1, Max Schumm2, Jon C Gould, MD1. 1Medical College of Wisconsin, 2UCLA
Introduction: Laparoscopic fundoplication remains the current gold standard surgical intervention for medically refractory gastroesophageal reflux disease. Studies suggest that on average 5-10% of patients undergo reoperative surgery due to recurrent, persistent, or new symptoms. The primary objective of this study was to characterize the long-term symptomatic outcomes of primary and reoperative fundoplications in a clinical series of patients who have undergone one or more fundoplications.
Methods: Patients who underwent laparoscopic primary or reoperative fundoplication between 2011 and 2017 by a single surgeon were retrospectively identified using a prospectively maintained database. Patients undergoing takedown of a failed fundoplication and conversion to Roux-en Y gastric bypass (for morbid obesity, severe gastroparesis, or 3 or more prior failed attempts) were excluded from the current analysis. All procedures were performed laparoscopically. Patients were asked to complete the validated GERD-Health Related Quality of Life (GERD-HRQL) survey prior to surgery and postoperatively at standard intervals to assess long-term symptomatic outcomes and quality of life. GERD-HRQL composite scores range from 0 (highest disease-related quality of life) to 50 (lowest disease-related quality of life, most severe symptoms).
Results: In total, there were 136 (62.4%) primary and 82 (37.6%) reoperative fundoplications that met inclusion criteria. Of the reoperative patients in this series, 67 (81.7%) were undergoing their first reoperative fundoplication and 15 (18.3%) their second reoperative fundoplication. Most primary patients underwent a Nissen (61.0%) while most reoperative patients underwent a Toupet fundoplication (59.8%). Primary fundoplication patients were significantly more likely to be on GERD medications prior to surgery than reoperative patients (92.6% vs. 75.6%; p<0.01). There were no conversions to laparotomy and no mortalities. Prior to surgery, GERD-HRQL scores were similar for primary and reoperative patients (primary 27.2 ± 11.4 vs. reoperative 23.5 ± 12.9; p=0.10). At two years follow-up, primary fundoplication patients had a significantly better GERD-related quality of life compared to reoperative patients (primary 8.70 ± 7.77 vs. reoperative 14.33 ± 13.54; p=0.02). Prior to surgery, 83.1% of primary patients reported dissatisfaction with their present condition and 87.0% of reoperative patients were dissatisfied. At two years, 12/42 (28.6%) reoperative patients and 7/46 (15.2%) primary patients reported dissatisfaction with their condition (p=0.13).
Conclusions: Patients who need to undergo reoperative fundoplication have more severe GERD-related symptoms at 2 years post-op compared to patients undergoing primary fundoplication. However, good outcomes and morbidity rates of laparoscopic reoperation that approximate that of a primary fundoplication are possible in the hands of an experienced surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85037
Program Number: P435
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster