Surgical Endoscopy

, Volume 27, Issue 5, pp 1579–1586 | Cite as

Predicting patient dissatisfaction following laparoscopic Nissen fundoplication: an analysis of symptoms

Article

Abstract

Background

Nissen fundoplication is a well-established treatment for gastroesophageal reflux disease (GERD) with a high success rate and a long-lasting effect. However, the literature reports that a persistent, small group of patients is not fully satisfied with the outcome. Identifying this patient group preoperatively would prevent disappointment for both patients and surgeon. This has proven difficult since dissatisfaction was related to nondisease-related factors instead of typical symptoms of GERD or the objective findings of investigations. We studied our series of patients who underwent laparoscopic Nissen fundoplication to identify predictors of patient dissatisfaction and the impact of surgery on individual symptoms.

Methods

All consecutive private patients undergoing Nissen fundoplication were asked to complete a preoperative and postoperative questionnaire concerning symptoms, medication use, and satisfaction. Demographics, investigations, complications, and reinterventions were documented. A standard laparoscopic Nissen fundoplication was performed.

Results

Over an 11-year period 222 patients underwent surgery for GERD. The postoperative response rate to the questionnaire was 77.5 %, with dissatisfaction reported by 12.8 % of the patients. Of these dissatisfied patients, only 13.6 % had proven disease recurrence. Both satisfied and dissatisfied patients presented with an inconsistent pattern of symptoms. None of the preoperative symptoms and investigations or the patient’s age and gender was predictive of postoperative dissatisfaction. Only postoperative heartburn, regurgitation, and bloating significantly correlated with patient dissatisfaction.

Conclusion

Nissen fundoplication has a very high satisfaction rate overall. A small percentage of patients are not fully satisfied and dissatisfaction is associated with reported persistent symptoms and side effects of surgery rather than gender or preoperative symptom pattern, severity of esophagitis, or total 24 h esophageal acid exposure.

Keywords

Esophagus Gastroesophageal reflux disease Fundoplication Signs and symptoms 

Notes

Acknowledgments

We are grateful for the excellent help given by Debbie Osborn and Mary Joslen for their aid in gathering and processing the patient data.

Disclosures

Drs. E. Beenen, P. Fogarty, and R. H. Roberts have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of SurgeryChristchurch HospitalChristchurchNew Zealand
  2. 2.The Hernia ClinicChristchurchNew Zealand

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