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Surgical Endoscopy

, Volume 21, Issue 11, pp 1978–1984 | Cite as

Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes

  • Craig B. Morgenthal
  • Edward Lin
  • Matthew D. Shane
  • John G. Hunter
  • C. Daniel Smith
Article

Abstract

Background

A small but significant percentage of patients are considered failures after laparoscopic Nissen fundoplication (LNF). We sought to identify preoperative predictors of failure in a cohort of patients who underwent LNF more than 10 years ago.

Methods

Of 312 consecutive patients undergoing primary LNF between 1992 and 1995, recent follow-up was obtained from 166 patients at a mean of 11.0 ± 1.2 years. Eight additional patients who underwent reoperation were lost to follow-up but are included. Failure is broadly defined as any reoperation, lack of satisfaction, or any severe symptoms at follow-up. Potential predictors evaluated included sex, age, body-mass index (BMI), response to acid reducing medications (ARM), psychiatric history, typical versus atypical symptoms, manometry, esophageal pH, and others. Logistic regression was used to assess significance of predictors in univariate analysis.

Results

Of 174 known outcomes, 131 were classified as successful (75.3%), while 43 were failures (24.7%): 26 reoperations, 13 unsatisfied, and 13 with severe symptoms. Response and lack of response to ARM were associated with 77.1% and 56.0% success rates respectively (P = 0.035). Eighty five percent of patients with typical symptoms had a successful outcome, compared to only 41% with atypical symptoms (P < 0.001). Preoperative morbid obesity (BMI > 35 kg/m2) was associated with failure (P = 0.036), while obesity (BMI 30–34.9 kg/m2) was not. A history of psychiatric illness trended toward significance (P = 0.06).

Conclusions

In a cohort with 11 years follow-up after LNF, factors predictive of a successful outcome include preoperative response to ARM, typical symptoms, and BMI < 35 kg/m2. Patients with atypical symptoms, no response to ARM, or morbid obesity should be informed of their higher risk of failure. Some patients in these groups do have successful outcomes, and further research may clarify which of these patients can benefit from LNF.

Keywords

GERD Laparoscopic Nissen fundoplication Outcomes Preoperative prediction 

References

  1. 1.
    Anvari M, Allen C, Marshall J, Armstrong D, Goeree R, Ungar W, Goldsmith C (2006) A 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):238–249PubMedCrossRefGoogle Scholar
  2. 2.
    Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Malm A, Sutherland I, Walan A (2007) Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. Br J Surg 94:198–203PubMedCrossRefGoogle Scholar
  3. 3.
    Lundell L, Miettinen P, Myrvold HE, Pedersen SA, Liedman B, Hatlebakk JG, Julkonen R, Levander K, Carlsson J, Lamm M, Wiklund I (2001) Continued (5-year) follow-up of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease. J Am Coll Surg 192(2):172–179PubMedCrossRefGoogle Scholar
  4. 4.
    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 92:695–699PubMedCrossRefGoogle Scholar
  5. 5.
    Mehta S, Bennett J, Mahon D, Rhodes M (2006) Prospective trial of laparoscopic Nissen fundoplication versus proton pump inhibitor therapy for gastroesophageal reflux disease: seven-year follow-up. J Gastrointest Surg 10(9):1312–1317PubMedCrossRefGoogle Scholar
  6. 6.
    Morgenthal CB, Shane MD, Stival A, Gletsu N, Milam G, Swafford V, Hunter JG, Smith CD (in press) The durability of laparoscopic Nissen fundoplication: eleven year outcomes. J Gastrointest SurgGoogle Scholar
  7. 7.
    Bammer T, Hinder RA, Klaus A, Klingler PJ (2001) Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg 5:42–48PubMedCrossRefGoogle Scholar
  8. 8.
    Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, Jehaes C (2006) Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 20:159–165PubMedCrossRefGoogle Scholar
  9. 9.
    Hunter JG, Trus TL, Branum G, Waring JP, Wood WC (1996) A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 223:673–687PubMedCrossRefGoogle Scholar
  10. 10.
    Anvari M, Allen C (2003) Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. J Am Coll Surg 196(1):51–57PubMedCrossRefGoogle Scholar
  11. 11.
    Peters JH, DeMeester TR, Crookes P, Oberg S, de Vos Shoop M, Hagen J, Bremner CG (1998) The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with “typical” symptoms. Ann Surg 228(1):40–50PubMedCrossRefGoogle Scholar
  12. 12.
    Johnson DA (2004) Endpoints for the assessment of response to gastroesophageal reflux disease therapy- what are the appropriate measures of “success”? Rev Gastroenterol Disord 4(3):118–129PubMedGoogle Scholar
  13. 13.
    O’Boyle CJ, Watson DI, DeBeaux, Jamieson GG (2002) Preoperative prediction of long-term outcome following laparoscopic fundoplication. ANZ J Surg 72:471–475Google Scholar
  14. 14.
    Power C, Maguire D, McAnena O (2004) Factors contributing to failure of laparoscopic Nissen fundoplication and the predictive value of preoperative assessment. Am J Surg 187:457–463PubMedCrossRefGoogle Scholar
  15. 15.
    Campos GMR, Peters JH, DeMeester TR, Öberg S, Crookes PF, Tan S, DeMeester SR, Hagen JA, Bremner CG (1999) Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 3(3):292–300PubMedCrossRefGoogle Scholar
  16. 16.
    Pidoto RR, Fama F, Giacobbe G, Florio MAG, Cogliandolo A (2006) Quality of life and predictors of long-term outcome in patients undergoing open Nissen fundoplication for chronic gastroesophageal reflux. Am J Surg 191:470–478PubMedCrossRefGoogle Scholar
  17. 17.
    Jackson PG, Gleiber MA, Askari R, Evans SRT (2001) Predictors of outcome in 100 consecutive laparoscopic antireflux procedures. Am J Surg 181:231–235PubMedCrossRefGoogle Scholar
  18. 18.
    Khajanchee YS, O’Rourke RW, Lockhart B, Patterson EJ, Hansen PD, Swanstrom LL (2002) Postoperative symptoms and failure after antireflux surgery. Arch Surg 137:1008–1014PubMedCrossRefGoogle Scholar
  19. 19.
    Lord RVN, Kaminski A, Öberg S, Bowrey DJ, Hagen JA, DeMeester SR, Sillin LF, Peters JH, Crookes PF, DeMeester TR (2002) Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg 6:3–10PubMedCrossRefGoogle Scholar
  20. 20.
    Soper NJ, Dunnegan D (1999) Anatomic fundoplication failure after laparoscopic antireflux surgery. Ann Surg 229(5):669–677PubMedCrossRefGoogle Scholar
  21. 21.
    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 16:1037–1041PubMedCrossRefGoogle Scholar
  22. 22.
    Sontag SJ, O’Connell S, Khandelwal S, Greenlee H, Schnell T, Nemchausky B, Chejfec G, Miller T, Seidel J, Sonnenberg A (2003) Asthmatics with gastroesophageal reflux: long term results of a randomized trial of medical and surgical antireflux therapies. Am J Gastroenterol 98(5):987–999PubMedGoogle Scholar
  23. 23.
    Anvari M, Allen C (2003) Surgical outcome in gastro-esophageal reflux disease patients with inadequate response to proton pump inhibitors (2003) Surg Endosc 17:1029–1035PubMedCrossRefGoogle Scholar
  24. 24.
    Anvari M, Bamehriz F (2006) Outcome of laparoscopic Nissen fundoplication in patients with body mass index ≥ 35. Surg Endosc 20(2):230–234PubMedCrossRefGoogle Scholar
  25. 25.
    Patterson EJ, Davis DG, Khajanchee Y, Swanstrom LL (2003) Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc 17(10):1561–1565PubMedCrossRefGoogle Scholar
  26. 26.
    Velanovich V, Karmy-Jones R (2001) Psychiatric disorders affect outcomes of antireflux operations for gastroesophageal reflux disease. Surg Endosc 15:171–175PubMedCrossRefGoogle Scholar
  27. 27.
    Kamolz T, Granderath FA, Pointer R (2003) Does major depression in patients with gastroesophageal reflux disease affect the outcome of laparoscopic antireflux surgery? Surg Endosc 17:55–60PubMedCrossRefGoogle Scholar
  28. 28.
    Khajanchee YS, Hong D, Hansen PD, Swanstrom LL (2004) Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results. Am J Surg 187(5):599–603PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Craig B. Morgenthal
    • 1
  • Edward Lin
    • 1
  • Matthew D. Shane
    • 1
  • John G. Hunter
    • 2
  • C. Daniel Smith
    • 3
  1. 1.Endosurgery Unit, Department of SurgeryEmory University School of MedicineAtlantaUSA
  2. 2.Department of SurgeryOregon Health Sciences UniversityPortlandOregon
  3. 3.Department of SurgeryMayo ClinicJacksonvilleUSA

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