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Predicting patient dissatisfaction following laparoscopic Nissen fundoplication: an analysis of symptoms

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Abstract

Background

Nissen fundoplication is a well-established treatment for gastroesophageal reflux disease (GERD) with a high success rate and a long-lasting effect. However, the literature reports that a persistent, small group of patients is not fully satisfied with the outcome. Identifying this patient group preoperatively would prevent disappointment for both patients and surgeon. This has proven difficult since dissatisfaction was related to nondisease-related factors instead of typical symptoms of GERD or the objective findings of investigations. We studied our series of patients who underwent laparoscopic Nissen fundoplication to identify predictors of patient dissatisfaction and the impact of surgery on individual symptoms.

Methods

All consecutive private patients undergoing Nissen fundoplication were asked to complete a preoperative and postoperative questionnaire concerning symptoms, medication use, and satisfaction. Demographics, investigations, complications, and reinterventions were documented. A standard laparoscopic Nissen fundoplication was performed.

Results

Over an 11-year period 222 patients underwent surgery for GERD. The postoperative response rate to the questionnaire was 77.5 %, with dissatisfaction reported by 12.8 % of the patients. Of these dissatisfied patients, only 13.6 % had proven disease recurrence. Both satisfied and dissatisfied patients presented with an inconsistent pattern of symptoms. None of the preoperative symptoms and investigations or the patient’s age and gender was predictive of postoperative dissatisfaction. Only postoperative heartburn, regurgitation, and bloating significantly correlated with patient dissatisfaction.

Conclusion

Nissen fundoplication has a very high satisfaction rate overall. A small percentage of patients are not fully satisfied and dissatisfaction is associated with reported persistent symptoms and side effects of surgery rather than gender or preoperative symptom pattern, severity of esophagitis, or total 24 h esophageal acid exposure.

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References

  1. Yang H, Watson DI, Kelly J, Lally CJ, Myers JC, Jamieson GG (2007) Esophageal manometry and clinical outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 11(9):1126–1133

    Article  PubMed  Google Scholar 

  2. Mickevicius A, Endzinas Z, Kiudelis M, Jonaitis L, Kupcinskas L, Maleckas A, Pundzius J (2008) Influence of wrap length on the effectiveness of Nissen and Toupet fundoplication: a prospective randomized study. Surg Endosc 22(10):2269–2276

    Article  PubMed  Google Scholar 

  3. Watson DI, Jamieson GG, Lally C, Archer S, Bessell JR, Booth M, Cade R, International Society for Diseases of the Esophagus–Australasian Section et al (2004) Multicenter, prospective, double-blind, randomized trial of laparoscopic Nissen vs anterior 90 degrees partial fundoplication. Arch Surg 139(11):1160–1167

    Article  PubMed  Google Scholar 

  4. Bohmer RD, Roberts RH, Utley RJ (2000) Open Nissen fundoplication and highly selective vagotomy as a treatment for gastro-oesophageal reflux disease. Aust N Z J Surg 70(1):22–25

    Article  PubMed  CAS  Google Scholar 

  5. Anvari M, Allen C, Marshall J, Armstrong D, Goeree R, Ungar W, Goldsmith CA (2006) Randomized controlled trial of laparoscopic Nissen fundoplication versus proton pump inhibitors for treatment of patients with chronic gastroesophageal reflux disease: One-year follow-up. Surg Innov 13(4):238–249

    Article  PubMed  Google Scholar 

  6. Lundell L, Attwood S, Ell C, Fiocca R, Galmiche JP, Hatlebakk J, Lind T, Junghard O, LOTUS trial collaborators (2008) Comparing laparoscopic antireflux surgery with esomeprazole in the management of patients with chronic gastro-oesophageal reflux disease: a 3-year interim analysis of the LOTUS trial. Gut 57((9):1207–1213

    Article  PubMed  CAS  Google Scholar 

  7. Mahon D, Rhodes M, Decadt B, Hindmarsh A, Lowndes R, Beckingham I, Koo B, Newcombe RG (2005) Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux. Br J Surg 92(6):695–699

    Article  PubMed  CAS  Google Scholar 

  8. Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Malm A, Sutherland I, Walan A, Nordic GORD Study Group (2007) Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. Br J Surg 94(2):198–203

    Article  PubMed  CAS  Google Scholar 

  9. Broeders JA, Rijnhart-de Jong HG, Draaisma WA, Bredenoord AJ, Smout AJ, Gooszen HG (2009) Ten-year outcome of laparoscopic and conventional Nissen fundoplication: randomized clinical trial. Ann Surg 250(5):698–706

    Article  PubMed  Google Scholar 

  10. Cai W, Watson DI, Lally CJ, Devitt PG, Game PA, Jamieson GG (2008) Ten-year clinical outcome of a prospective randomized clinical trial of laparoscopic Nissen versus anterior 180(degrees) partial fundoplication. Br J Surg 95(12):1501–1505

    Article  PubMed  CAS  Google Scholar 

  11. Cowgill SM, Gillman R, Kraemer E, Al-Saadi S, Villadolid D, Rosemurgy A (2007) Ten-year follow-up after laparoscopic Nissen fundoplication for gastroesophageal reflux disease. Am Surg 73(8):748–752

    PubMed  Google Scholar 

  12. Nijjar RS, Watson DI, Jamieson GG, Archer S, Bessell JR, Booth M, Cade R, International Society for the Diseases of the Esophagus-Australasian Section et al (2010) Five-year follow-up of a multicenter, double-blind randomized clinical trial of laparoscopic Nissen vs anterior 90 degrees partial fundoplication. Arch Surg 145(6):552–557

    Article  PubMed  Google Scholar 

  13. Morgenthal CB, Lin E, Shane MD, Hunter JG, Smith CD (2007) Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc 21(11):1978–1984

    Article  PubMed  Google Scholar 

  14. Draaisma WA, Rijnhart-de Jong HG, Broeders IA, Smout AJ, Furnee EJ, Gooszen HG (2006) Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication: a randomized trial. Ann Surg 244(1):34–41

    Article  PubMed  Google Scholar 

  15. Wijnhoven BP, Watson DI, Devitt PG, Game PA, Jamieson GG (2008) Laparoscopic Nissen fundoplication with anterior versus posterior hiatal repair: long-term results of a randomized trial. Am J Surg 195(1):61–65

    Article  PubMed  Google Scholar 

  16. O’Boyle CJ, Watson DI, DeBeaux AC, Jamieson GG (2002) Preoperative prediction of long-term outcome following laparoscopic fundoplication. ANZ J Surg 72(7):471–475

    Article  PubMed  Google Scholar 

  17. Beck PE, Watson DI, Devitt PG, Game PA, Jamieson GG (2009) Impact of gender and age on the long-term outcome of laparoscopic fundoplication. World J Surg 33(12):2620–2626

    Article  PubMed  Google Scholar 

  18. Håkanson BS, Thor KB, Thorell A, Ljungqvist O (2007) Open vs laparoscopic partial posterior fundoplication. A prospective randomized trial. Surg Endosc 21(2):289–298

    Article  PubMed  Google Scholar 

  19. Yang H, Watson DI, Lally CJ, Devitt PG, Game PA, Jamieson GG (2008) Randomized trial of division versus nondivision of the short gastric vessels during laparoscopic Nissen fundoplication: 10-year outcomes. Ann Surg 247(1):38–42

    Article  PubMed  Google Scholar 

  20. Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD, SAGES Guidelines Committee (2010) Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 24(11):2647–2669

    Article  PubMed  Google Scholar 

  21. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, Johnson F et al (1999) Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 45(2):172–180

    Article  PubMed  CAS  Google Scholar 

  22. Broeders JA, Draaisma WA, Bredenoord AJ, de Vries DR, Rijnhart-de Jong HG, Smout AJ, Gooszen HG (2009) Oesophageal acid hypersensitivity is not a contraindication to Nissen fundoplication. Br J Surg 96(9):1023–1030

    Article  PubMed  CAS  Google Scholar 

  23. Broeders JA, Draaisma WA, Bredenoord AJ, Smout AJ, Broeders IA, Gooszen HG (2010) Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease. Br J Surg 97(6):845–852

    Article  PubMed  CAS  Google Scholar 

  24. Broeders JA, Roks DJ, Draaisma WA, Vlek AL, Hazebroek EJ, Broeders IA, Smout AJ (2011) Predictors of objectively identified recurrent reflux after primary Nissen fundoplication. Br J Surg 98(5):673–679

    Article  PubMed  CAS  Google Scholar 

  25. Woodcock SA, Watson DI, Lally C, Archer S, Bessell JR, Booth M, Cade R, International Society for Disease of the Esophagus - Australasian Section et al (2006) Quality of life following laparoscopic anterior 90 degrees versus Nissen fundoplication: results from a multicenter randomized trial. World J Surg 30(10):1856–1863

    Article  PubMed  Google Scholar 

  26. Lord RV, Kaminski A, Oberg S, Bowrey DJ, Hagen JA, DeMeester SR, Sillin LF et al (2002) Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg 6(1):3–9 discussion 10

    Article  PubMed  Google Scholar 

  27. Lord RV, DeMeester SR, Peters JH, Hagen JA, Elyssnia D, Sheth CT, DeMeester TR (2009) Hiatal hernia, lower esophageal sphincter incompetence, and effectiveness of Nissen fundoplication in the spectrum of gastroesophageal reflux disease. J Gastrointest Surg 13(4):602–610

    Article  PubMed  Google Scholar 

  28. Allen CJ, Anvari M (2002) Preoperative symptom evaluation and esophageal acid infusion predict response to laparoscopic Nissen fundoplication in gastroesophageal reflux patients who present with cough. Surg Endosc 16(7):1037–1041

    Article  PubMed  CAS  Google Scholar 

  29. Riedl O, Gadenstätter M, Lechner W, Schwab G, Marker M, Ciovica R (2009) Preoperative lower esophageal sphincter manometry data neither impact manifestations of GERD nor outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 13(7):1189–1197

    Article  PubMed  Google Scholar 

  30. Mathew G, Watson DI, Myers JC, Holloway RH, Jamieson GG (1997) Oesophageal motility before and after laparoscopic Nissen fundoplication. Br J Surg 84(10):1465–1469

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We are grateful for the excellent help given by Debbie Osborn and Mary Joslen for their aid in gathering and processing the patient data.

Disclosures

Drs. E. Beenen, P. Fogarty, and R. H. Roberts have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Christchurch Hospital, 2 Riccarton Avenue, Addington, 8011, Christchurch, New Zealand

    Edwin Beenen & Ross H. Roberts

  2. The Hernia Clinic, 1/9 Caledonian Rd., Merivale, 8014, Christchurch, New Zealand

    Paul Fogarty & Ross H. Roberts

Authors
  1. Edwin Beenen
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  2. Paul Fogarty
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  3. Ross H. Roberts
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Corresponding author

Correspondence to Edwin Beenen.

Additional information

Presented as an oral presentation at the combined meeting of the Australian and New Zealand Gastric and Oesophageal Surgery Association and the Australian and New Zealand Hepatic, Pancreatic & Biliary Association, Queenstown, New Zealand, 28–29 September 2010.

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Beenen, E., Fogarty, P. & Roberts, R.H. Predicting patient dissatisfaction following laparoscopic Nissen fundoplication: an analysis of symptoms. Surg Endosc 27, 1579–1586 (2013). https://doi.org/10.1007/s00464-012-2630-8

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  • DOI: https://doi.org/10.1007/s00464-012-2630-8

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