Long-term Symptom Control and Satisfaction Scores in Patients Undergoing Primary Anti-reflux Surgery

Ananth Srinivasan, Masato Hoshino, Amith V Reddy, Tommy H Lee, Sumeet K Mittal. Creighton University Medical Center

Background: Aim of this study was to evaluate the long-term outcomes of Primary Anti-Reflux Surgery (ARS).

Methods: After IRB approval, a retrospective review of prospectively maintained database was done to identify patients who underwent a primary ARS by the senior author with 5 years or greater follow up. Symptoms included heartburn, regurgitation, dysphagia and chest pain. Significant symptoms were defined to have a grade of 2 or 3. All data was expressed as median (IQR) or mean (range). Chi-square test was used to compare categorical variables. Mann-Whitney’s U test and Wilcoxon test were used to compare continuous variables. A p-value < 0.05 was considered statistically significant.

Results: A total of 207 patients underwent ARS from September 2003 to September 2006. There were 125 (60%) females and the median age of the entire group was 53 (IQR: 43-77). 198 surgeries (95.6%) were completed laparoscopically while 1 (0.5%) and 8 (3.9%) were performed via laparotomy and left thoracotomy respectively. A Nissen fundoplication was performed in 175 (84.5%) patients. A Collis gastroplasty was required in 5.8% of the patients to complete the fundoplication. A follow up on 115 (56%) was obtained and the mean follow up time was 70.4 months (60-89). There was significant differences between the mean scores of heartburn (1.36 vs 0.4; p < 0.001), regurgitation (0.82 vs 0.12; p < 0.001) and chest pain (0.52 vs 0.3; p = 0.024). There was also a statistically significant proportion of patients reporting a decrease in significantly severe (defined as a score of 2 or 3) symptoms for heartburn (60% vs 7%; p < 0.001), regurgitation (33% vs 2%; p < 0.001), dysphagia (18% vs 7%; p = 0.005) and chest pain (24% vs 6%; p < 0.001). The mean satisfaction score was 8.67 with 79% of the patients queried reporting excellent satisfaction scores (8 or greater). A good percentage (84%) of the patients responded positively when asked if they would recommend their procedure to someone. 31.2% reported continuation of some form of medication for reflux (22.6% PPI, 4.3% H2 blockers & 4.3%% antacids).

Conclusion: Long-term follow up of patients who underwent primary ARS has shown very good outcomes as measured by significant improvement in severity of symptoms and patient satisfaction scores.

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