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Surgical Endoscopy

, Volume 26, Issue 11, pp 3225–3231 | Cite as

Hiatal hernia, Barrett’s esophagus, and long-term symptom control after laparoscopic fundoplication for gastroesophageal reflux

  • Johannes MiholicEmail author
  • Joumanah HafezEmail author
  • Johannes Lenglinger
  • Fritz Wrba
  • Christiane Wischin
  • Katrin Schütz
  • Marcus Hudec
Article

Abstract

Background

The aim of this study was to determine the long-term symptom control after laparoscopic fundoplication for gastroesophageal reflux disease (GERD), and possible prognostic factors.

Methods

A cohort of 271 patients, operated on at a university hospital from 1996 through 2002, was eligible for evaluation after a median interval of 102 months (range = 12–158). The time between surgery and recurrence of reflux symptoms (i.e., time to treatment failure) served as the end point for statistical analysis. Putative risk factors for symptom recurrence were analyzed by univariate analysis and by using Cox’s multiple-hazards regression.

Results

According to Kaplan–Meier estimates, the rate of reflux symptom recurrence was 15 % after 108 months, 11 % in cases without intestinal metaplasia, but 43 % in patients with long-segment (≥3 cm) Barrett’s esophagus (BE; p < 0.0001). Reflux symptoms recurred in 22 % of cases with a hiatal hernia (HH) ≥3 cm before operation, but only in 7 % with smaller or absent HH (p = 0.005). Multivariate analysis revealed a relative risk of 6.6 (CI = 3.0–13.0) for long-segment BE and 3.0 (CI = 1.7–10.1) for HH ≥ 3 cm. A strong statistical interaction was found between HH ≥ 3 cm and long-segment BE: the small group (n = 18) of cases exhibiting both risk factors had an exaggerated recurrence rate of 72 % at 108 months.

Conclusions

Laparoscopic fundoplication for symptomatic GERD provided a long-lasting abolition of reflux symptoms in 231 of 271 (85 %) patients. HH ≥ 3 cm and long-segment BE were shown as independent prognostic factors favoring recurrence.

Keywords

GERD Gastroesophageal reflux disease Fundoplication Prognostic factor Long-term outcome Hiatal hernia Barrett’s esophagus 

Notes

Disclosures

Johannes Miholic, Joumanah Hafez, Johannes Lenglinger, Fritz Wrba, Christiane Wischin, Katrin Schütz, and Marcus Hudec have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Johannes Miholic
    • 1
    Email author
  • Joumanah Hafez
    • 1
    • 3
    Email author
  • Johannes Lenglinger
    • 1
  • Fritz Wrba
    • 2
  • Christiane Wischin
    • 1
  • Katrin Schütz
    • 1
  • Marcus Hudec
    • 4
  1. 1.Department of Surgery, Allgemeines KrankenhausMedical University of ViennaViennaAustria
  2. 2.Department of Pathology, Allgemeines KrankenhausMedical University of ViennaViennaAustria
  3. 3.Department of ENTMedical Faculty of Martin-Luther-University Halle-WittenbergHalle an der SaaleGermany
  4. 4.Department of Scientific ComputingUniversity of ViennaViennaAustria

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