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Laparoscopic Toupet Fundoplication for the Treatment of Laryngopharyngeal Reflux: Results at Medium-Term follow-Up

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Abstract

Background

The effect of laparoscopic Toupet fundoplication (LTF) for the treatment of laryngopharyngeal reflux (LPR) is unclear. The purpose of this study is to investigate the feasibility and effectiveness of LTF for the treatment of LPR-related symptoms and disease-specific quality of life (QoL) up to 3-year follow-up.

Materials and methods

Observational cohort study (2015–2019). Patients suffering from LPR were included. Preoperative evaluation included esophagogastroduodenoscopy, esophageal manometry and 24-h pH/impedance study. Symptoms and QoL were measured with the reflux symptom index (RSI) and the laryngopharyngeal reflux–health-related quality of life (LPR–HRQL) validate questionnaires at baseline and during follow-up.

Results

Eighty-six patients were included. Twenty-three (27%) patients had pure LPR while 63 (73%) presented with combined LPR/GERD. Cough (89.7%), dyspnea/choking (39.6%) and asthma (25.6%) were the most commonly reported extraesophageal symptoms. The median (interquartile range, IQR) total RSI score before operation and at 3-month, 6-month, 1-year, 2-year and 3-year follow-up was 36.1 (10.3), 9.58 (12.3), 11.8 (10.2), 12.4 (9.6), 12.0 (13.1) and 10.1 (12.0), respectively. The median (IQR) total LPR–HRQL score before operation and at 3-month, 6-month, 1-year, 2-year and 3-year follow-up was 57.4 (22.2), 13.4 (14.9), 15.2 (12.8), 11.4 (10.9) and 11.9 (13.5), respectively. The subscores “voice,” “cough,” “throat” and “swallow” showed a significant improvement after intervention. Compared to baseline, each per-year follow-up pairwise comparison was significantly improved (p < 0.001).

Conclusions

LTF seems feasible, effective and promising for the treatment of LPR with improved symptoms and disease-specific patients’ quality of life perception up to 3-year follow-up.

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Authors and Affiliations

  1. Department of Biomedical Science for Health, Division of Minimally Invasive Surgery, Istitituto Clinico Sant’Ambrogio, University of Milan, Via Faravelli n.16, Milan, Italy

    Alberto Aiolfi, Greta Saino, Andrea Sozzi, Emanuele Rausa, Gianluca Bonitta & Davide Bona

  2. Department of Surgery, Istituto Clinico Sant’Ambrogio, University of Insubria, Milan, Italy

    Marta Cavalli

  3. University of Maryland Medical Center, Baltimore, MD, USA

    Desmond Khor

Authors
  1. Alberto Aiolfi
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  2. Marta Cavalli
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  3. Greta Saino
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  4. Desmond Khor
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  5. Andrea Sozzi
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  8. Davide Bona
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Contributions

Literature search: A.A, AS, ER and MC. Study designs: AA and DB. Data collection: AA, LB, AS, GB, ER and GS. Data analysis: AA, GB and DB. Data interpretation: AA, GB and DB. Writing: AA, DK and DB. Manuscript critical revision: all authors.

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Correspondence to Alberto Aiolfi.

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The authors have no conflict of interest.

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The study was approved by the Institutional Review Board and is in accordance with the 1964 Helsinki Declaration.

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Informed consent was obtained from all patients.

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Figure 1

Reflux symptom index (RSI) The RSI was calculated preoperatively, and at 3 months, 6 months, 1 year, 2 years and 3 years after laparoscopic Toupet fundoplication (LTF). The red line indicates the RSI 13 threshold and the black interrupted line indicates the RSI 19 threshold. An RSI above the threshold score of 19 defines the presence of pathologic LPR. The shaded box bounds the 25–75% confidence interval, the error bars bound the 10–90% confidence interval. The solid line within the box represents the median. (JPJ 36 kb)

Figure 2

laryngopharyngeal reflux–health-related quality of life score (LPR–HRQL). The LPR–HRQL was calculated preoperatively, and at 3 months, 6 months, 1 year, 2 years and 3 years after laparoscopic Toupet fundoplication (LTF). The shaded box bounds the 25–75% confidence interval, the error bars bound the 10–90% confidence interval. The solid line within the box represents the median. (JPJ 27 kb)

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Aiolfi, A., Cavalli, M., Saino, G. et al. Laparoscopic Toupet Fundoplication for the Treatment of Laryngopharyngeal Reflux: Results at Medium-Term follow-Up. World J Surg 44, 3821–3828 (2020). https://doi.org/10.1007/s00268-020-05653-5

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