Shunsuke Akimoto, Saurabh Singhal, Sumeet K Mittal. Creighton University Medical Center
Introduction: As Antireflux surgeries have become common, more patients are presenting with needs for reoperative interventions. We assessed our patients for short, mid and long term subjective outcomes following redo fundoplication.
Methods: After IRB approval, from a prospectively managed database, patients who underwent redo fundoplication between December 2003 and June 2010 were identified. Patients were categorized as Group A: short term follow-up (1-2 years), Group B: mid term follow-up 2-5 years, and Group C: long term follow-up (≥5 years). Subjective symptoms [0(low)-3(high)], satisfaction [1(low)-10(high)] and use of medications were compared between the groups. Symptom score of 2 and 3 were taken as severe symptom and satisfaction score of 8-10 as excellent satisfaction.
Results: A total of 203 patients underwent redo-anti-reflux surgery during the study period, of which 130 who underwent redo fundoplication form the cohort for this study. Follow-up at short term, mid term and long term was available for 63 patients, 74 patients and 60 patients respectively. Severe heartburn and regurgitation were significantly more common in group C than group A (heartburn: 38.3% vs. 12.7% p <0.001, regurgitation: 20% vs. 6.3% p=0.023). Severe chest pain was significantly more common in group C than group B (11.7 % vs. 6.3% p=0.043). Group A patients had significantly less requirement for proton pump inhibitor (14.3% vs. 35.1% vs. 33.3%, p=0.004 for group A vs. group B, p =0.011 for group A vs. group C). The satisfaction score of ≥8 was seen in significantly lesser number of patients in group C as compared with group A (65% vs. 82.3% p=0.025).
Conclusion: The long term follow-up following redo fundoplication is associated with worsening of reflux symptoms i.e. heartburn and regurgitation. As a result, fewer patients have excellent satisfaction in long-term follow-up.