Presenting Symptoms As a Predictive Factor for Multiple Postoperative Visits in Patients With Intact Fundoplication for GERD

Andreas Tschoner, MD1, Michelle Han, MD2, Michal Lada, MD2, Carolyn Jones, MD2, Christian Peyre, MD2, Thomas Watson, MD2, Jeffrey H Peters, MD2. 1Department of Surgery Hospital Barmherzige Schwestern Linz, 2Department of Surgery, University of Rochester Medical Center

Purpose: After fundoplication for gastroesophageal reflux disease (GERD), some patients complain of persistent preoperative symptoms even though their fundoplication is intact and GERD is objectively controlled. The aim of our study was to determine if particular preoperative symptoms predict which patients will seek multiple follow-up visits after otherwise successful antireflux surgery.

Methods: The charts of 396 patients who underwent fundoplication for GERD between 1/2005 and 8/2012 were retrospectively reviewed. Pre- and post-operative symptoms were divided into typical, laryngorespiratory, digestive and oropharyngeal.

Results: 350 patients met inclusion criteria, 329 (94.0%) having undergone a laparoscopic Nissen fundoplication. The median follow-up time was 51 months. Of the total of 1082 symptoms reported, 74% were typical, 19% laryngorespiratory, 6% digestive and 1% oropharyngeal. 71/350 (20%) of patients sought additional follow-up after their initial routine postoperative checks. Patients with sore throat (p=0.014), foul taste (p=0.019), and chest pain as a primary symptom (p=0.040) were more likely to request multiple clinic visits, as were patients with only one presenting symptom (p=0.001) and those with chronic back pain as a comorbidity (p=0.002).

Conclusions: Sore throat, foul taste and chest pain were found to be predictive of the need for multiple postoperative visits. These symptoms likely were not due to GERD and, therefore, were not improved with antireflux surgery. A thorough symptom assessment is important prior to fundoplication, including a detailed analysis of the symptoms likely to respond or not to surgery.

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