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Measuring the Effectiveness of Laparoscopic Nissen Fundoplication: Long Term Results
Denise W Gee, Michael T Andreoli, David W Rattner
Massachusetts General Hospital, Boston, MA
OBJECTIVE: To evaluate the long-term results and quality of life of patients undergoing laparoscopic Nissen fundoplication (LNF).
DESIGN: A validated survey instrument, the Gastroesophageal Reflux Disease--Health-Related Quality-of-Life scale (GERD-HRQL) was mailed to all patients who underwent LNF from 1997-2006. Additional information was obtained regarding re-intervention, satisfaction, and medication use.
SETTING: Tertiary care referral center.
PATIENTS: 412 consecutive patients who underwent either primary LNF or laparoscopic re-do fundoplications (re-do LNF) by a single surgeon from 1997-2006.
MAIN OUTCOME MEASURES: GERD-HRQL score, re-operation rate, antisecretory medication usage.
RESULTS: A 46% response rate (188/412) was obtained. Median follow-up was 60 months (range 4-75 months). Mean GERD-HRQL score was 5.25 +/- 7.67 (scale range 0-45 with 0 representing no symptoms). 72% of patients were “satisfied” with the long-term result of surgery. 87% of patients stated they would have the surgery again. 44% of patients took antireflux medications at some point following surgery. Half of those on medication had no diagnostic testing to document the recurrence of GERD. Only three patients (2%) undergoing primary LNF required re-operation. Patients undergoing re-do LNF had higher GERD-HRQL scores (mean 13.6 +/- 10.8), lower satisfaction (43%) and greater probability of requiring antisecretory medication (71%).
CONCLUSIONS: This is the largest reported series of LNF from New England with long-term follow up. Contrary to reports in the medical literature, our results demonstrate that patients undergoing primary LNF by an experienced surgical team have near normal GERD-HRQL scores at long-term follow up, low re-operation rates, and are satisfied with their decision to undergo surgery. The results following re-do LNF are not as good, highlighting the importance of patient selection and proper surgical technique when performing primary LNF.
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