World Journal of Surgery

, Volume 40, Issue 5, pp 1137–1144 | Cite as

Measuring Outcomes of Laparoscopic Anti-reflux Surgery: Quality of Life Versus Symptom Scores?

  • Jan H. Koetje
  • Vincent B. Nieuwenhuijs
  • Tanya Irvine
  • George C. Mayne
  • David I. WatsonEmail author
Original Scientific Report



Outcome following fundoplication for gastroesophageal reflux can be measured using objective tests, symptom scores and quality of life (QoL) measures. Which is best and how these assessments correlate is uncertain. To determine the utility of assessment measures we compared a general QoL measure (SF-36) and a disease-specific measure (GERD-hr-QoL) with symptom and satisfaction scores in individuals following fundoplication.


329 individuals underwent fundoplication between 2000 and 2015 in 2 centres in Australia and the Netherlands. Patients were assessed before and 3, 12 and 24 months after surgery using 10-point Likert scales to assess heartburn and satisfaction, the SF-36 questionnaire and the GERD-hr-QoL questionnaire. SF-36 scores were converted into component scores: Physical Component Scale (PCS) score and Mental Component Scale (MCS) score. Correlations between QoL measures and clinical outcomes were determined.


Surgery relieved heartburn (7.0 vs. 0.0 median, P < 0.001) and patients were highly satisfied with the outcome (median 9.0). PCS and MCS scores improved after surgery (PCS 40.9 vs. 46.0, P < 0.001; MCS 47.6 vs. 50.3, P = 0.027). GERD-hr-QoL scores also improved after surgery (15.7 vs. 3.7, P < 0.001). Correlations between PCS and MCS scores versus heartburn and satisfaction scores were generally weak or absent. However, correlations between GERD-hr-QoL versus heartburn and satisfaction scores were moderate to strong.


Despite improvements in scores, the SF-36 correlated poorly with clinical outcome measures, and its use to measure outcome following fundoplication is questioned. However, the GERD-hr-QoL correlated well with the symptom scores, suggesting this disease-specific QoL measure is a better tool for assessing anti-reflux surgery outcome.


Satisfaction Score Laparoscopic Fundoplication Partial Fundoplication Physical Component Scale Mental Component Scale 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are grateful for our colleagues who contributed patients to this study, and for the assistance of Ms Lorelle Smith and Ms Nicky Ascott who maintained the database and obtained the SF-36 follow-up for the Australian cohort. Follow-up of the Australian cohort was supported by Research Project Grants from the National Health and Medical Research Council (NHMRC) of Australia—Grant Numbers 375111 and 1022722.


  1. 1.
    Camilleri M, Dubois D, Coulie B, Jones M, Kahrilas PJ, Rentz AM et al (2005) Prevalence and socioeconomic impact of upper gastrointestinal disorders in the United States: results of the US Upper Gastrointestinal Study. Clin Gastroenterol Hepatol 3:543–552CrossRefPubMedGoogle Scholar
  2. 2.
    Engström C, Cai W, Irvine T, Devitt PG, Thompson SK, Game PA, Bessell JR, Jamieson GG, Watson DI (2012) Twenty years of experience with laparoscopic antireflux surgery. Br J Surg 99:1415–1421CrossRefPubMedGoogle Scholar
  3. 3.
    Watson DI, Pike GK, Baigrie RJ, Mathew G, Devitt PG, Britten-Jones R, Jamieson GG (1997) Prospective double blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 226:642–652CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Koetje JH, Irvine T, Thompson SK, Devitt PG, Woods SD, Aly A, Jamieson GG, Watson DI (2015) Quality of life following repair of large hiatal hernia is improved but not influenced by use of mesh: results from a randomized controlled trial. World J Surg 39:1465–1473. doi: 10.1007/s00268-015-2970-3 CrossRefPubMedGoogle Scholar
  5. 5.
    Watson DI, Jamieson GG, Pike GK, Davies N, Richardson M, Devitt PG (1999) Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg 86:123–130CrossRefPubMedGoogle Scholar
  6. 6.
    Yang H, Watson DI, Lally CJ, Devitt PG, Game PA, Jamieson GG (2008) Randomized trial of division versus non-division of the short gastric vessels during laparoscopic Nissen fundoplication—10 year outcomes. Ann Surg 247:38–42CrossRefPubMedGoogle Scholar
  7. 7.
    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 partial fundoplication. Br J Surg 95:1501–1505CrossRefPubMedGoogle Scholar
  8. 8.
    Woodcock SA, Watson DI, Lally C, Archer S, Bessell JR, Booth M et al (2006) Quality of life following laparoscopic anterior 90 degrees versus Nissen fundoplication: results from a multicenter randomized trial. World J Surg 30:1856–1863. doi: 10.1007/s00268-005-0623-7 CrossRefPubMedGoogle Scholar
  9. 9.
    Kamolz T, Wykypiel H Jr, Bammer T, Pointner R (1998) Quality of life after laparoscopic antireflux surgery—Nissen fundoplication. Chirurg 69:947–950CrossRefPubMedGoogle Scholar
  10. 10.
    Kamolz T, Pointner R, Velanovich V (2003) The impact of gastroesophageal reflux disease on quality of life. Surg Endosc 17:1193–1199CrossRefPubMedGoogle Scholar
  11. 11.
    Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June–22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948Google Scholar
  12. 12.
    Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183:217–224PubMedGoogle Scholar
  13. 13.
    Revicki DA, Wood M, Maton PN, Sorensen S (1998) The impact of gastroesophageal reflux disease on health-related quality of life. Am J Med 104:252–258CrossRefPubMedGoogle Scholar
  14. 14.
    Glise H, Hallerback B, Johansson B (1995) Quality-of-life assessments in evaluation of laparoscopic Rossetti fundoplication. Surg Endosc 9:183–188CrossRefPubMedGoogle Scholar
  15. 15.
    Granderath FA, Kamolz T, Schweiger UM, Pointner R (2002) Quality of life, surgical outcome, and patient satisfaction three years after laparoscopic Nissen fundoplication. World J Surg 26:1234–1238. doi: 10.1007/s00268-002-6416-3 CrossRefPubMedGoogle Scholar
  16. 16.
    Velanovich V (1998) Comparison of generic (SF-36) vs. disease-specific (GERD-HRQL) quality-of-life scales for gastroesophageal reflux disease. J Gastrointest Surg. 2:141–145CrossRefPubMedGoogle Scholar
  17. 17.
    Watson DI, Jamieson GG, Lally C, Archer S, Bessell JR, Booth M, Cade R, Cullingford G, Devitt PG, Fletcher DR, Hurley J, Kiroff G, Martin C, Martin IJG, Nathanson LK, Windsor J (2004) Multicentre prospective double blind randomized trial of laparoscopic Nissen versus anterior 90 degree partial fundoplication. Arch Surg 139:1160–1167CrossRefPubMedGoogle Scholar
  18. 18.
    Daud WMBW, Thompson SK, Jamieson GG, Devitt PG, Martin IJG, Watson DI (2014) Randomized controlled trial of laparoscopic anterior 180 partial vs. posterior 270 partial fundoplication. ANZ J Surg. doi: 10.1111/ans.12476 Google Scholar
  19. 19.
    Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 33(4 Suppl):AS264–AS279PubMedGoogle Scholar
  20. 20.
    Tosato F, Marano S, Mattacchine S, Luongo B, Mingarelli V, Campagna G (2012) Quality of life after Nissen-Rossetti fundoplication. Surg Laparosc Endosc Percutan Tech 22:205–209CrossRefPubMedGoogle Scholar
  21. 21.
    Rossetti G, Limongelli P, Cimmino M, Napoletano D, Bondanese MC, Romano G, Pratilas M, Guerriero L, Orlando F, Conzo G, Amato B, Docimo G, Tolone S, Brusciano L, Docimo L, Fei L (2014) Outcome of medical and surgical therapy of GERD: predictive role of quality of life scores and instrumental evaluation. Int J Surg 12:112–116CrossRefGoogle Scholar
  22. 22.
    Korolija D, Sauerland S, Wood-Dauphinee S, Abbou CC, Eypasch E, Caballero MG et al (2004) Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 18:879–897CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Jan H. Koetje
    • 1
    • 2
  • Vincent B. Nieuwenhuijs
    • 1
  • Tanya Irvine
    • 2
  • George C. Mayne
    • 2
  • David I. Watson
    • 2
    Email author
  1. 1.Department of SurgeryIsala, ZwolleOverijsselThe Netherlands
  2. 2.Flinders University Department of SurgeryFlinders Medical CentreBedford ParkAustralia

Personalised recommendations