Brexton Turner, BS, Melissa Helm, Emily Hetzel, Max Schumm, Jon Gould. Medical College of Wisconsin
Background: Satisfaction rates following laparoscopic fundoplication for gastroesophageal reflux (GERD) may vary based on the integrity of the gastroesophageal junction (GEJ) at the time of surgery. We hypothesized that patients with a competent GEJ do not fare as well following fundoplication for GERD compared to patients with an incompetent GEJ.
Methods: This is a retrospective review of prospectively maintained data on subjects who underwent primary laparoscopic fundoplication (Nissen or Toupet) for GERD. Three esophageal manometry variables were used to determine GEJ competency: (1) hiatal hernia (normal = no hernia), (2) total lower esophageal sphincter length (normal > 2.43 cm), and (3) lower esophageal sphincter pressure (normal = 15.0-43.7 mmHg). Competent GEJ patients had normal values for all 3 variables. Symptomatic outcomes were assessed with the GERD Health Related Quality of Life (HRQL) survey administered at defined intervals. Paired t-tests were used for intragroup bivariate analysis and one-way ANOVA to compare survey responses.
Results: A total of 78 patients met inclusion criteria – 17 competent GEJ and 61 incompetent GEJ patients. GERD-HRQL scores improved in the incompetent cohort at all intervals out to 2 years postop. GERD-HRQL improved in the competent cohort out to 2 months, with no difference at 6 months or 2 years postop compared to preop scores. Competent GEJ patients receiving a Nissen fundoplication had a higher rate of additional procedures (endoscopy with or without dilation, pH studies) following surgery to address GERD symptoms compared to Toupet.
Conclusions: GERD patients with a competent GEJ report a lower GERD-related quality of life with more frequent and severe reflux symptoms up to two-years post-fundoplication. Competent GEJ patients receiving a Nissen fundoplication are more likely to have additional procedures to address recurrent or persistent symptoms following surgery. Surgeons should approach patients with a competent GEJ with caution as fundoplication outcomes in these patients may be worse than the incompetent GEJ population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91906
Program Number: S048
Presentation Session: Foregut II – Physiology
Presentation Type: Podium