Search

Background Limited evidence exists to which operation gives best long-term outcomes for gastro-oesophageal reflux disease. This study aimed to assess long-term symptomatic outcome and satisfaction following laparoscopic anterior ( LA) or Nissen fundoplication in a specialist upper gastrointestinal unit. Methods Patients who underwent primary LA or Nissen ( LN) fundoplication between May 1994 and June 2010 were identified from a prospectively collected database. DeMeester, modified DeMeester, 'Gastrointestinal Symptom Rating Scale' scores and patient satisfaction were assessed by questionnaire. Results A total of 387 patients underwent surgery and 246 patients (65%) completed questionnaires, with 181 LA patients and 65 LN patients. Median follow-up was 83 months for LA and 179 months for LN ( P < 0.001). A total of 218/245 (89%) reported major improvement in symptoms and 27 (11%) reported poor outcomes. There was no differences between LA and LN for symptom scores at short (<5 years) or long-term follow-up (>5 years). Women reported significantly higher DeMeester scores and lower satisfaction ( P = 0.012). One hundred and eighteen (48%) patients were taking proton pump inhibitors ( PPI) at follow-up despite high satisfaction rates. Conclusion LA and LN have similar long-term results with patients reporting high satisfaction levels. Women reported more symptoms and less satisfaction than men. Despite high satisfaction rates a high percentage of patients take PPIs. [ABSTRACT FROM AUTHOR]

Currently gastro-oesophageal reflux disease (GORD) can be managed either medically or surgically. The management decision is often based on the referring doctor's perception of the pros and cons of surgical management versus the medical alternative. A large group of gastroenterologists was surveyed to determine their understanding of the common outcomes of surgical management of GORD. A 15-question survey was sent to all gastroenterologists in Australia who were members of the Gastroenterology Society of Australia. Questions centred on management decisions and postoperative symptoms in fundoplication patients. The findings were compared to current published outcome data. One hundred and thirty-four gastroenterologists responded anonymously to the survey. More than 75% described fundoplication as a safe and established procedure, and 80% had referred patients who were well controlled on medication for surgical management. The gastroenterologists’ perceptions of the problems of postoperative dysphagia and bloating differed from published outcomes. Gastroenterologists are often the gatekeepers for the management of patients with GORD. The understanding that this group has about surgical outcomes is important so that patients can make well-informed management decisions. The present study found that gastroenterologists are likely to convey to their patients higher degrees of postoperative dysphagia and bloating following fundoplication than is actually reported. This may deter some patients who would benefit from fundoplication from consulting a surgeon. [ABSTRACT FROM AUTHOR]