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Surgical Endoscopy

, Volume 29, Issue 9, pp 2520–2524 | Cite as

20 years later: laparoscopic fundoplication durability

  • Ben RobinsonEmail author
  • Christy M. Dunst
  • Maria A. Cassera
  • Kevin M. Reavis
  • Ahmed Sharata
  • Lee L. Swanstrom
Article

Abstract

Background

Laparoscopic surgery for gastrointestinal reflux disease was introduced in 1991. Early safety, efficacy, and 5–10-year durability have been amply documented, but long-term patient outcomes have been criticized. This study presents 20-year outcomes after laparoscopic fundoplication (LF) in a consecutive patient cohort.

Methods

Patients who underwent primary LF procedures for gastroesophageal reflux disease (GERD) were identified from a prospectively collected IRB-approved database (1991–1995). A phone symptom questionnaire was administered using a 5-point validated GERD scoring system (heartburn, regurgitation, and dysphagia). Symptomatic success was defined by a lack of surgical re-intervention and a low symptom score.

Results

One-hundred and ninety-three patients were identified during the time period. Fifty-one patients completed the survey (100 lost to follow-up, 40 deceased, 2 declined to answer). Respondents had a median follow-up of 19.7 years. Overall, 38/51 (74.5 %) of patients reported complete control of heartburn and regurgitation. Ten patients reported only occasional heartburn. Eight of fifty-one (16 %) reported daily dysphagia, and 22/51 (43 %) of respondents were using proton pump inhibitors at the time of telephone interview. Nine of fifty-one (18 %) underwent revision of the original surgery which did not negatively impact the satisfaction rating, with 8/9 (89 %) of these patients reporting the highest satisfaction rating. Overall, 46/51 (90 %) were satisfied with their choice of surgery.

Conclusion

Long-term results from the early experience with LF are excellent with 94 % of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up. However, 18 % required surgical revision surgery to maintain their results. There is a relatively high rate of daily dysphagia but 90 % of patients are happy to have had LF.

Keywords

Fundoplication Durability Nissen Long-term outcomes Anti-reflux surgery GERD 

Notes

Disclosures

Ben Robinson, Christy M. Dunst, Maria A. Cassera, Kevin M. Reavis, Ahmed Sharata, and Lee L. Swanstrom have no conflicts of interest or financial relationships to disclose.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ben Robinson
    • 1
    Email author
  • Christy M. Dunst
    • 1
    • 2
    • 3
  • Maria A. Cassera
    • 3
  • Kevin M. Reavis
    • 1
    • 2
  • Ahmed Sharata
    • 1
  • Lee L. Swanstrom
    • 1
    • 2
    • 3
    • 4
  1. 1.Foundation for Surgical Innovation and EducationPortlandUSA
  2. 2.Division for Gastrointestinal Minimally Invasive SurgeryThe Oregon ClinicPortlandUSA
  3. 3.Providence Cancer CenterPortlandUSA
  4. 4.Institut Hospitalo UniversitaireStrasbourgFrance

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