World Journal of Surgery

, Volume 35, Issue 2, pp 342–348 | Cite as

Laparoscopic Antireflux Surgery in Patients with Throat Symptoms: A Word of Caution

  • Dharmendran Ratnasingam
  • Tanya Irvine
  • Sarah K. Thompson
  • David I. Watson



A subset of patients undergoing laparoscopic fundoplication presents with atypical throat symptoms, and the benefit of surgery in these patients is debated. These patients can present with throat symptoms alone or in combination with typical reflux symptoms. We evaluated the clinical outcome in these patients and compared their outcomes with a larger group of patients who did not have throat symptoms before fundoplication.


Outcome data for 893 consecutive patients who underwent a laparoscopic fundoplication from January 2002 to June 2008 were collected prospectively and managed on a database. Ninety-three patients with atypical throat symptoms were identified, and divided into subgroups with (n = 66) and without (n = 27) typical reflux symptoms (heartburn and/or regurgitation), and outcomes were compared with patients (n = 800) who didn’t have throat symptoms. Symptoms were assessed with analog symptom scores for heartburn and dysphagia, as well as satisfaction with the surgical outcome. Case records for patients with throat symptoms were also reviewed to obtain more detail about specific throat symptoms and their resolution.


Cough was the commonest atypical symptom, followed by sore throat. Heartburn scores improved following surgery in all patient groups. Dysphagia was more common 3 months after surgery in patients without throat symptoms, although there were no differences for dysphagia at later follow-up. Following surgery satisfaction scores were highest in patients with atypical throat symptoms who also had typical reflux symptoms, and the scores were lowest in patients who only had atypical throat symptoms. Nearly twice as many patients who had throat and reflux symptoms reported improvement or resolution of symptoms, compared to patients who only had throat symptoms.


Fundoplication achieves a good outcome in patients with atypical throat symptoms who also report typical symptoms of reflux. However, surgeons should be cautious about operating on the subgroup of patients with objective evidence of gastroesophageal reflux who describe throat symptoms but do not report heartburn or regurgitation. In this subgroup, expectations of a good outcome should be minimized.


  1. 1.
    Thompson SK, Cai W, Jamieson GG et al (2009) Recurrent symptoms after fundoplication with a negative pH studyrecurrent reflux or functional heartburn? J Gastrointest Surg 13:54–60CrossRefPubMedGoogle Scholar
  2. 2.
    Kelly JJ, Watson DI, Chin KF et al (2007) Laparoscopic Nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg 205:570–575CrossRefPubMedGoogle Scholar
  3. 3.
    Sgromo B, Irvine LA, Cuschieri A et al (2008) Long-term comparative outcome between laparoscopic total Nissen and Toupet fundoplication: symptomatic relief, patient satisfaction and quality of life. Surg Endosc 22:1048–1053CrossRefPubMedGoogle Scholar
  4. 4.
    Cai W, Watson DI, Lally CJ et al (2008) Ten-year clinical outcome of a prospective randomized clinical trial of laparoscopic Nissen versus anterior 180 partial fundoplication. Br J Surg 95:1501–1505CrossRefPubMedGoogle Scholar
  5. 5.
    Iqbal M, Batch AJ, Moorthy K et al (2009) Outcome of surgical fundoplication for extra-oesophageal symptoms of reflux. Surg Endosc 23:557–561CrossRefPubMedGoogle Scholar
  6. 6.
    Westcott CJ, Hopkins MB, Bach K et al (2004) Fundoplication for laryngopharyngeal reflux disease. J Am Coll Surg 199:23–30CrossRefPubMedGoogle Scholar
  7. 7.
    Poelmans J, Feenstra L, Tack J (2006) Determinants of long-term outcome of patients with reflux-related ear, nose, and throat symptoms. Dig Dis Sci 51:282–288CrossRefPubMedGoogle Scholar
  8. 8.
    Ford CN (2005) Evaluation and management of laryngopharyngeal reflux. JAMA 294:1534–1540CrossRefPubMedGoogle Scholar
  9. 9.
    Catania RA, Kavic SM, Roth J et al (2007) Laparoscopic Nissen fundoplication effectively relieves symptoms in patients with laryngopharyngeal reflux. J Gastrointest Surg 11:1579–1588CrossRefPubMedGoogle Scholar
  10. 10.
    Duffy JP, Maggard M, Hiyama DT et al (2010) Reflux and cough. Otolaryngol Clin North Am 43:97–110CrossRefGoogle Scholar
  11. 11.
    Kaufman JA, Houghland JE, Quiroga E et al (2006) Long-term outcomes of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)-related airway disorder. Surg Endosc 20:1824–1830CrossRefPubMedGoogle Scholar
  12. 12.
    Chen RY, Thomas RJ (2000) Results of laparoscopic fundoplication where atypical symptoms coexist with oesophageal reflux. ANZ J Surg 70:840–842CrossRefGoogle Scholar
  13. 13.
    Farrell TM, Richardson WS, Trus TC et al (2001) Response of atypical symptoms of gastro-oesophageal reflux to antireflux surgery. Br J Surg 88:1649–1652CrossRefPubMedGoogle Scholar
  14. 14.
    So JB, Zeitels SM, Rattner DW (1998) Outcomes of atypical symptoms attributed to gastroesophageal reflux treated by laparoscopic fundoplication. Surgery 124:28–32PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Dharmendran Ratnasingam
    • 1
  • Tanya Irvine
    • 1
  • Sarah K. Thompson
    • 2
  • David I. Watson
    • 1
  1. 1.Department of SurgeryFlinders University, Flinders Medical CentreBedford ParkAustralia
  2. 2.Discipline of SurgeryUniversity of AdelaideAdelaideAustralia

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