Long-Term Patient Outcomes After Laparoscopic Anti-Reflux Procedures

Anton Simorov, Ajay Ranade, Rachel Jones, Carl Tadaki, Valerie Shostrom, Eugene Boilesen, Dmitry Oleynikov

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Laparoscopic anti-reflux surgery with or without large hiatal hernia has been shown to have good short-term outcomes. However, limited data are available on long-term outcomes of greater than 5 years. The aim of this study is to review functional and symptomatic outcomes of anit-reflux surgery in a large tertiary referral medical center. Methods: Two hundred ninety-seven patients who underwent anti-reflux surgery at the University of Nebraska Medical Center between 2002 and 2013 were included in this study. Patient data including pre- and post-operative studies and symptom questionnaires were prospectively collected and the database was used to analyze postoperative outcomes. Results: A total of 297 Nissen fundoplications, 35 redo fundoplications and 22 Toupet procedures were performed. Mean BMI was 30.0 ± 6.2. The median follow-up was 70 (6-135) months. There were three reoperations (0.9 %) for recurrent symptoms. Mesh was used in 210 cases where hiatal hernia was larger than 2 cm. Median preoperative DeMeester score was 50.8 ± 46. There was a statistically significant improvement in composite heartburn score (83 % (CI 78.2, 87.7); p < 0.05), regurgitation (81.1 % (CI 76.1, 86.1); p < 0.05), and belching (63 % (CI 56.7, 69.3); p < 0.05). Atypical presentation such as pulmonary (e.g., aspiration (25.8 % (CI 20, 31.6), wheezing (20.3 % (CI 15, 25.6); p < 0.05), and throat symptoms (e.g., laryngitis 28 % (CI 22.1, 33.9); p < 0.05) also improved. Available radiographic studies for patients more than 3 years follow-up show an overall recurrence of 33.9 % (47.8 % in hiatal hernia > 5 cm repaired with mesh). Of those with recurrence, over 84 % were asymptomatic at follow-up. Conclusions: This study shows that patients had excellent symptom control and low rates of complications and reoperations in long-term follow-up. We found that typical gastro intestinal symptoms responded better compared with atypical symptoms in spite of clear evidence of reflux on preoperative studies. Hiatal hernia was very commonly seen in our patient population and long-term radiographic follow-up suggest that asymptomatic recurrence may be high but rarely requires any surgical intervention. Anti-reflux surgery with correction of hiatal hernia if present is safe and effective in long-term follow-up.

Original languageEnglish (US)
Pages (from-to)157-163
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number1
DOIs
StatePublished - Jan 1 2014

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Hiatal Hernia
Fundoplication
Reoperation
Recurrence
Heartburn
Tertiary Care Centers
Databases
Population

Keywords

  • Fundoplication
  • Hiatal
  • Long-term
  • Outcomes
  • Reflux
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Simorov, A., Ranade, A., Jones, R., Tadaki, C., Shostrom, V., Boilesen, E., & Oleynikov, D. (2014). Long-Term Patient Outcomes After Laparoscopic Anti-Reflux Procedures. Journal of Gastrointestinal Surgery, 18(1), 157-163. https://doi.org/10.1007/s11605-013-2401-4

Long-Term Patient Outcomes After Laparoscopic Anti-Reflux Procedures. / Simorov, Anton; Ranade, Ajay; Jones, Rachel; Tadaki, Carl; Shostrom, Valerie; Boilesen, Eugene; Oleynikov, Dmitry.

In: Journal of Gastrointestinal Surgery, Vol. 18, No. 1, 01.01.2014, p. 157-163.

Research output: Contribution to journalArticle

Simorov, A, Ranade, A, Jones, R, Tadaki, C, Shostrom, V, Boilesen, E & Oleynikov, D 2014, 'Long-Term Patient Outcomes After Laparoscopic Anti-Reflux Procedures', Journal of Gastrointestinal Surgery, vol. 18, no. 1, pp. 157-163. https://doi.org/10.1007/s11605-013-2401-4
Simorov A, Ranade A, Jones R, Tadaki C, Shostrom V, Boilesen E et al. Long-Term Patient Outcomes After Laparoscopic Anti-Reflux Procedures. Journal of Gastrointestinal Surgery. 2014 Jan 1;18(1):157-163. https://doi.org/10.1007/s11605-013-2401-4
Simorov, Anton ; Ranade, Ajay ; Jones, Rachel ; Tadaki, Carl ; Shostrom, Valerie ; Boilesen, Eugene ; Oleynikov, Dmitry. / Long-Term Patient Outcomes After Laparoscopic Anti-Reflux Procedures. In: Journal of Gastrointestinal Surgery. 2014 ; Vol. 18, No. 1. pp. 157-163.
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AU - Simorov, Anton

AU - Ranade, Ajay

AU - Jones, Rachel

AU - Tadaki, Carl

AU - Shostrom, Valerie

AU - Boilesen, Eugene

AU - Oleynikov, Dmitry

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N2 - Background: Laparoscopic anti-reflux surgery with or without large hiatal hernia has been shown to have good short-term outcomes. However, limited data are available on long-term outcomes of greater than 5 years. The aim of this study is to review functional and symptomatic outcomes of anit-reflux surgery in a large tertiary referral medical center. Methods: Two hundred ninety-seven patients who underwent anti-reflux surgery at the University of Nebraska Medical Center between 2002 and 2013 were included in this study. Patient data including pre- and post-operative studies and symptom questionnaires were prospectively collected and the database was used to analyze postoperative outcomes. Results: A total of 297 Nissen fundoplications, 35 redo fundoplications and 22 Toupet procedures were performed. Mean BMI was 30.0 ± 6.2. The median follow-up was 70 (6-135) months. There were three reoperations (0.9 %) for recurrent symptoms. Mesh was used in 210 cases where hiatal hernia was larger than 2 cm. Median preoperative DeMeester score was 50.8 ± 46. There was a statistically significant improvement in composite heartburn score (83 % (CI 78.2, 87.7); p < 0.05), regurgitation (81.1 % (CI 76.1, 86.1); p < 0.05), and belching (63 % (CI 56.7, 69.3); p < 0.05). Atypical presentation such as pulmonary (e.g., aspiration (25.8 % (CI 20, 31.6), wheezing (20.3 % (CI 15, 25.6); p < 0.05), and throat symptoms (e.g., laryngitis 28 % (CI 22.1, 33.9); p < 0.05) also improved. Available radiographic studies for patients more than 3 years follow-up show an overall recurrence of 33.9 % (47.8 % in hiatal hernia > 5 cm repaired with mesh). Of those with recurrence, over 84 % were asymptomatic at follow-up. Conclusions: This study shows that patients had excellent symptom control and low rates of complications and reoperations in long-term follow-up. We found that typical gastro intestinal symptoms responded better compared with atypical symptoms in spite of clear evidence of reflux on preoperative studies. Hiatal hernia was very commonly seen in our patient population and long-term radiographic follow-up suggest that asymptomatic recurrence may be high but rarely requires any surgical intervention. Anti-reflux surgery with correction of hiatal hernia if present is safe and effective in long-term follow-up.

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