Herbert M Hedberg, MD1, Tyler Hall, BS2, Kristine Kuchta, MS2, John Linn, MD2, Stephen Haggerty, MD2, Woody Denham, MD2, JoAnn Carbray2, Michael B Ujiki, MD2. 1University of Chicago Medical Center, 2NorthShore University HealthSystem
Background: Laparoscopic fundoplication (LF) is often performed to treat paraesophageal hernia and/or GERD. Care is taken to select the right patients for the operation. Some patients may not improve, and others experience dysphagia or bloating after surgery. Factors associated with patient satisfaction after fundoplication would be helpful during the patient selection process.
Methods: A retrospective review of a prospectively collected database was performed. Queried patients underwent LF from 2009 to 2015. Non-elective operations and fundoplications after heller myotomy were excluded. Of this cohort, patients were included only if they responded to a two-year postoperative quality of life survey. Surveys were distributed preoperatively, at three weeks, at one year, and at two years. The surveys include the Reflux Severity Index, GERD-HRQL, and Dysphagia Score. The GERD-HRQL asks about patient satisfaction with their current state (1=dissatisfied, 2=somewhat satisfied, 3=very satisfied). The cohort was divided according to their answer to this question at two years. Demographics and preoperative factors were compared between the groups with Kruskal-Wallis and Fisher’s Exact tests. Univariable and multivariable ordinal logistic regression was performed to identify preoperative symptoms associated with satisfaction at two years. Scores on the surveys over time were were also analyzed.
Results: A total of 94 patients were included in the analysis (dissatisfied = 26, somewhat satisfied = 17, very satisfied = 51). The only significant demographic or preoperative difference was a high number of paraesophageal hernias in the ‘very satisfied’ cohort (p=0.017). On univariable regression, younger age and paraesophageal hernia predicted satisfaction. Several variables negatively predicted satisfaction with an OR <1. Multivariable regression, controlled for age and hernia type, identified throat clearing, post-nasal drip, and globus sensation as preoperative symptoms less likely to result in patient satisfaction (p=0.001, 0.001, and 0.02, respectively). Subgroup analysis of patients with paraesophageal hernias revealed that patients with bloating preoperatively are less likely to be satisfied at two years. Survey scores over time showed all groups improving over three weeks, but while satisfied patients continued to improved, dissatisfied patients symptomatically worsened over time.
Conclusion: This study confirms previous reports stating atypical symptoms of GERD are less likely to improve after LF. It also shows individuals with paraesophageal hernia tend to do quite well, unless they report bloating preoperatively. Patient-centered analysis such as this can be useful when discussing postoperative expectations with patients, and may reveal opportunities to individualize operative approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88434
Program Number: P389
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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