Surgical Endoscopy

, Volume 22, Issue 2, pp 343–347 | Cite as

Comparison of patient-centered outcomes after laparoscopic Nissen fundoplication for gastroesophageal reflux disease or paraesophageal hernia

  • Lisa A. Mark
  • Allan Okrainec
  • Lorenzo E. Ferri
  • Liane S. Feldman
  • Serge Mayrand
  • Gerald M. Fried



Patients undergoing laparoscopic Nissen fundoplication (LNF) with paraesophageal hernias (PEH) are not only older and less healthy than those with gastroesophageal reflux disease (GERD), but in addition the repair is more complicated. We evaluated whether outcomes relating to GERD symptoms and quality of life (QOL) were impacted by the presence of PEH.


Prospectively entered data from 149 patients (109 GERD and 40 PEH) were evaluated prior to and one year after LNF with standardized and validated symptoms scores. Scores for heartburn, dysphagia, disease-specific QOL (GERD-HRQL), and general health-related QOL (SF-12 physical and mental component scores) were compared between patients undergoing LNF for PEH or for GERD alone, at baseline and one year after surgery. p < 0.05 was considered statistically significant.


Preoperative data for GERD-HRQL, heartburn, and dysphagia were available for 134 patients, with 96% one-year follow-up. SF-12 data were collected for 98 patients with 100% follow-up. PEH patients were older and had greater comorbidity. Preoperative GERD-HRQL and heartburn were significantly worse in the GERD group. One year after surgery, both GERD and PEH patients showed significant improvement in GERD-HRQL, heartburn and dysphagia scores, with no difference in any of these disease or symptom measures between the two study groups. Postoperative PCS and MCS scores showed improvement in GERD patients, while PEH patient scores remained at or below the population mean.


LNF is equally effective as an antireflux procedure in both GERD and PEH patients, prevents symptoms of reflux in PEH patients that have none preoperatively, and does not increase dysphagia in either group. Despite the increased complexity of the procedure, LNF provides an effective control of reflux symptoms in patients undergoing PEH repair.


GERD Hiatal hernia Laparoscopy Fundoplication Quality of life Paraesophageal hernia 


  1. 1.
    Ronkainen J, Aro P, Storskrubb T, et al. (2006) Gastro-oesophageal reflux symptoms and health-related quality of life in the adult general population–the Kalixanda study. Aliment Pharmacol Ther 23(12):1725–1733CrossRefPubMedGoogle Scholar
  2. 2.
    Feldman LS, Mayrand S, Stanbridge D, Mercier L, Barkun JS, Fried GM (2001) Laparoscopic fundoplication: a model for assessing new technology in surgical procedures. Surgery 130(4):686–693; discussion 693–685CrossRefPubMedGoogle Scholar
  3. 3.
    Rattner DW (2000) Measuring improved quality of life after laparoscopic Nissen fundoplication. Surgery 127(3):258–263CrossRefPubMedGoogle Scholar
  4. 4.
    Terry M, Smith CD, Branum GD, Galloway K, Waring JP, Hunter JG (2001) Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia. Surg Endosc 15(7):691–699CrossRefPubMedGoogle Scholar
  5. 5.
    Pessaux P, Arnaud JP, Delattre JF, Meyer C, Baulieux J, Mosnier H (2005) Laparoscopic antireflux surgery: five-year results and beyond in 1340 patients. Arch Surg 140(10):946–951CrossRefPubMedGoogle Scholar
  6. 6.
    Lafullarde T, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG (2001) Laparoscopic Nissen fundoplication: five-year results and beyond. Arch Surg 136(2):180–184CrossRefPubMedGoogle Scholar
  7. 7.
    Skinner DB, Belsey RH (1967) Surgical management of esophageal reflux and hiatus hernia. Long-term results with 1,030 patients. J Thorac Cardiovasc Surg 53(1):33–54PubMedGoogle Scholar
  8. 8.
    Ferri LE, Feldman LS, Stanbridge D, Mayrand S, Stein L, Fried GM (2005) Should laparoscopic paraesophageal hernia repair be abandoned in favor of the open approach? Surg Endosc 19(1):4–8CrossRefPubMedGoogle Scholar
  9. 9.
    Casabella F, Sinanan M, Horgan S, Pellegrini CA (1996) Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 171(5):485–489CrossRefPubMedGoogle Scholar
  10. 10.
    Oelschlager BK, Eubanks TR, Oleynikov D, Pope C, Pellegrini CA (2002) Symptomatic and physiologic outcomes after operative treatment for extraesophageal reflux. Surg Endosc 16(7):1032–1036CrossRefPubMedGoogle Scholar
  11. 11.
    Horgan S, Eubanks TR, Jacobsen G, Omelanczuk P, Pellegrini CA (1999) Repair of paraesophageal hernias. Am J Surg 177(5):354–358CrossRefPubMedGoogle Scholar
  12. 12.
    Ware JE KM, Keller SD (1998) SF-12:how to score the SF-12 physical and mental health summary scales. 3rd ed Lincoln (RI): QualityMetric Inc.Google Scholar
  13. 13.
    Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 183(3):217–224PubMedGoogle Scholar
  14. 14.
    Pierre AF, Luketich JD, Fernando HC, et al. (2002) Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg 74(6):1909–1915; discussion 1915–1906CrossRefPubMedGoogle Scholar
  15. 15.
    Mattar SG, Bowers SP, Galloway KD, Hunter JG, Smith CD (2002) Long-term outcome of laparoscopic repair of paraesophageal hernia. Surg Endosc 16(5):745–749CrossRefPubMedGoogle Scholar
  16. 16.
    Dahlberg PS, Deschamps C, Miller DL, Allen MS, Nichols FC, Pairolero PC (2001) Laparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg 72(4):1125–1129CrossRefPubMedGoogle Scholar
  17. 17.
    Andujar JJ, Papasavas PK, Birdas T, et al. (2004) Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation. Surg Endosc 18(3):444–447CrossRefPubMedGoogle Scholar
  18. 18.
    Trus TL, Laycock WS, Waring JP, Branum GD, Hunter JG (1999) Improvement in quality of life measures after laparoscopic antireflux surgery. Ann Surg 229(3):331–336CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Lisa A. Mark
    • 1
    • 4
  • Allan Okrainec
    • 1
    • 4
  • Lorenzo E. Ferri
    • 1
    • 2
    • 4
  • Liane S. Feldman
    • 1
    • 4
  • Serge Mayrand
    • 3
  • Gerald M. Fried
    • 1
    • 4
    • 5
  1. 1.Divisions of General SurgeryMcGill UniversityMontrealCanada
  2. 2.Thoracic SurgeryMcGill UniversityMontrealCanada
  3. 3.GastroenterologyMcGill UniversityMontrealCanada
  4. 4.Steinberg-Bernstein Centre for Minimally Invasive SurgeryMcGill UniversityMontrealCanada
  5. 5.Montreal General HospitalMontrealCanada

Personalised recommendations