Journal of Gastrointestinal Surgery

, Volume 18, Issue 1, pp 157–163 | Cite as

Long-Term Patient Outcomes After Laparoscopic Anti-Reflux Procedures

  • Anton Simorov
  • Ajay Ranade
  • Rachel Jones
  • Carl Tadaki
  • Valerie Shostrom
  • Eugene Boilesen
  • Dmitry OleynikovEmail author
2013 SSAT Plenary Presentation



Laparoscopic anti-reflux surgery with or without large hiatal hernia has been shown to have good short-term outcomes. However, limited data are available on long-term outcomes of greater than 5 years. The aim of this study is to review functional and symptomatic outcomes of anit-reflux surgery in a large tertiary referral medical center.


Two hundred ninety-seven patients who underwent anti-reflux surgery at the University of Nebraska Medical Center between 2002 and 2013 were included in this study. Patient data including pre- and post-operative studies and symptom questionnaires were prospectively collected and the database was used to analyze postoperative outcomes.


A total of 297 Nissen fundoplications, 35 redo fundoplications and 22 Toupet procedures were performed. Mean BMI was 30.0 ± 6.2. The median follow-up was 70 (6–135) months. There were three reoperations (0.9 %) for recurrent symptoms. Mesh was used in 210 cases where hiatal hernia was larger than 2 cm. Median preoperative DeMeester score was 50.8 ± 46. There was a statistically significant improvement in composite heartburn score (83 % (CI 78.2, 87.7); p < 0.05), regurgitation (81.1 % (CI 76.1, 86.1); p < 0.05), and belching (63 % (CI 56.7, 69.3); p < 0.05). Atypical presentation such as pulmonary (e.g., aspiration (25.8 % (CI 20, 31.6), wheezing (20.3 % (CI 15, 25.6); p < 0.05), and throat symptoms (e.g., laryngitis 28 % (CI 22.1, 33.9); p < 0.05) also improved. Available radiographic studies for patients more than 3 years follow-up show an overall recurrence of 33.9 % (47.8 % in hiatal hernia > 5 cm repaired with mesh). Of those with recurrence, over 84 % were asymptomatic at follow-up.


This study shows that patients had excellent symptom control and low rates of complications and reoperations in long-term follow-up. We found that typical gastro intestinal symptoms responded better compared with atypical symptoms in spite of clear evidence of reflux on preoperative studies. Hiatal hernia was very commonly seen in our patient population and long-term radiographic follow-up suggest that asymptomatic recurrence may be high but rarely requires any surgical intervention. Anti-reflux surgery with correction of hiatal hernia if present is safe and effective in long-term follow-up.


Reflux Hiatal Fundoplication Surgery Outcomes Long-term 



  1. 1.
    El-Serag HB, Ergun GA, Pandolfino J, Fitzgerald S, Tran T, Kramer JR. Obesity increases oesophageal acid exposure. Gut. 2007;56:749–755.PubMedCrossRefGoogle Scholar
  2. 2.
    Gaynor EB. Laryngeal complications of GERD. J Clin Gastroenterol. 2000;30:S31-S34.PubMedGoogle Scholar
  3. 3.
    Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006;296:2947–2953.PubMedCrossRefGoogle Scholar
  4. 4.
    Peters JH, DeMeester TR, Crookes P, Oberg S, de Vos Shoop M, Hagen JA, Bremner CG. The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with "typical" symptoms. Ann Surg. 1998;228:40–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Oelschlager BK, Quiroga E, Parra JD, Cahill M, Polissar N, Pellegrini CA. Long-term outcomes after laparoscopic antireflux surgery. Am J Gastroenterol. 2008;103:280–287.PubMedCrossRefGoogle Scholar
  6. 6.
    Lee YK, James E, Bochkarev V, Vitamvas M, Oleynikov D. Long-term outcome of cruroplasty reinforcement with human acellular dermal matrix in large paraesophageal hiatal hernia. J Gastrointest Surg. 2008;12:811–815.PubMedCrossRefGoogle Scholar
  7. 7.
    Ringley CD, Bochkarev V, Ahmed SI, Vitamvas ML, Oleynikov D. Laparoscopic hiatal hernia repair with human acellular dermal matrix patch: our initial experience. Am J Surg. 2006 Dec;192(6):767–72.Google Scholar
  8. 8.
    Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg. 2011 Oct;213(4):461–8.Google Scholar
  9. 9.
    Oelschlager BK, Eubanks TR, Maronian N, Hillel A, Oleynikov D, Pope CE, Pellegrini CA. Laryngoscopy and pharyngeal pH are complementary in the diagnosis of gastroesophageal-laryngeal reflux. J Gastrointest Surg. 2002;6:189–194.PubMedCrossRefGoogle Scholar
  10. 10.
    Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmülling C, Neugebauer E, Troidl H. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg. 1995;82:216–222.PubMedCrossRefGoogle Scholar
  11. 11.
    Bloomston M, Nields W, Rosemurgy AS. Symptoms and antireflux medication use following laparoscopic Nissen fundoplication: outcome at 1 and 4 years. JSLS. 2003;7:211–218.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Patti MG, Arcerito M, Tamburini A, Diener U, Feo CV, Safadi B, Fisichella P, Way LW. Effect of laparoscopic fundoplication on gastroesophageal reflux disease-induced respiratory symptoms. J Gastrointest Surg. 2000;4:143–149.PubMedCrossRefGoogle Scholar
  13. 13.
    Morgenthal CB, Shane MD, Stival A, Gletsu N, Milam G, Swafford V, Hunter JG, Smith CD. The durability of laparoscopic Nissen fundoplication: 11-year outcomes. J Gastrointest Surg. 2007;11:693–700.PubMedCrossRefGoogle Scholar
  14. 14.
    Lee SK, Kim EK. Laparoscopic Nissen fundoplication in Korean patients with gastroesophageal reflux disease. Yonsei Med J. 2009;50:89–94.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Oelschlager BK, Petersen RP, Brunt LM, Soper NJ, Sheppard BC, Mitsumori L, Rohrmann C, Swanstrom LL, Pellegrini. Laparoscopic paraesophageal hernia repair: defining long-term clinical and anatomic outcomes. CA. J Gastrointest Surg. 2012;16:453–459.Google Scholar
  16. 16.
    Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremner CG. Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg. 2000;190:553–560.PubMedCrossRefGoogle Scholar
  17. 17.
    Schmidt E, Shaligram A, Reynoso JF, Kothari V, Oleynikov D. Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias. Dis Esophagus. 2013 Feb 26. [Epub ahead of print]Google Scholar
  18. 18.
    Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG, Demeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2009;23:1219–1226.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Anton Simorov
    • 1
  • Ajay Ranade
    • 1
  • Rachel Jones
    • 1
  • Carl Tadaki
    • 1
  • Valerie Shostrom
    • 1
  • Eugene Boilesen
    • 1
  • Dmitry Oleynikov
    • 1
    • 2
    Email author
  1. 1.Department of SurgeryUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.985126 Nebraska Medical CenterOmahaUSA

Personalised recommendations