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Partial Fundoplication is Effective Treatment for Female Patients with Gastroesophageal Reflux and Scleroderma: A Multicenter Comparative Cohort Study

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Abstract

Background

Patients with scleroderma often suffer from dysphagia and gastroesophageal reflux disease (GERD). Partial fundoplication is a validated anti-reflux procedure for GERD but may worsen dysphagia in scleroderma patients. Its utility in these patients is unknown. Here, we evaluate the efficacy and acceptability of partial fundoplication for the treatment of medically refractory GERD in patients with scleroderma.

Methods

Analysis of a prospectively maintained database of patients who underwent fundoplication across 14 hospitals between 1991 and 2019. Perioperative outcomes, reintervention rates, heartburn, dysphagia, and patient satisfaction were assessed at 3 months, 1- and 3-years post-surgery.

Results

A total of 17 patients with scleroderma were propensity score matched to 526 non-scleroderma controls. All underwent a partial fundoplication. Perioperative outcomes including complication rate, length of stay, and need for reoperation were similar between the two groups. Compared to baseline, both groups reported significantly improved heartburn at 3 months, 1- and 3-years following partial fundoplication. Surgery was equally effective at controlling heartburn across all follow-up timepoints in patients with or without scleroderma. Dysphagia to solids was more common in patients with scleroderma than controls at 3-months post-surgery, but was not significantly different to controls at 1- and 3-year follow-up. Satisfaction scores were high and comparable between both groups across all postoperative timepoints, with 100% of patients with scleroderma reporting that their initial choice to undergo surgery was correct.

Conclusions

Partial fundoplication controls reflux and is associated with a transient period of dysphagia to solids in patients with scleroderma. This approach is safe, effective and acceptable for patients with scleroderma and medically refractory GERD.

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Author information

Author notes

  1. Amanda Hii and David S. Liu are co-first authors.

Authors and Affiliations

  1. Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia

    Amanda Hii, David S. Liu, Tim Bright, David I. Watson & Sarah K. Thompson

  2. Department of Surgery, Austin Hospital, Heidelberg, VIC, 3084, Australia

    David S. Liu

  3. Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia

    Feruza Kholmurodova, Tanya Irvine, Tim Bright, David I. Watson & Sarah K. Thompson

Authors
  1. Amanda Hii
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  2. David S. Liu
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  3. Feruza Kholmurodova
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  4. Tanya Irvine
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  5. Tim Bright
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  6. David I. Watson
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  7. Sarah K. Thompson
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Contributions

All authors contributed to study design, data acquisition, data analysis, data interpretation, writing and final approval of the manuscript. All authors are accountable for the integrity of this study.

Corresponding author

Correspondence to David S. Liu.

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The authors declare that they do not have any conflict of interest.

Ethical approval

This study was approved by the South Adelaide Local Health Network Human Research Ethics Committee.

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Informed consent was waived by the Human Research Ethics Committee for this project.

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Hii, A., Liu, D.S., Kholmurodova, F. et al. Partial Fundoplication is Effective Treatment for Female Patients with Gastroesophageal Reflux and Scleroderma: A Multicenter Comparative Cohort Study. World J Surg 46, 147–153 (2022). https://doi.org/10.1007/s00268-021-06326-7

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  • DOI: https://doi.org/10.1007/s00268-021-06326-7

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