Prediction of postoperative gas bloating after laparoscopic antireflux procedures based on 24-h pH acid reflux pattern

Background:Postoperative gas/bloating (G/B) is a common sequelae after laparoscopic fundoplication. Patients with "upright" reflux are thought to have more aerophagic tendencies contributing to their GERD symptoms than patients with significant "supine" patterns of reflux. The risk of postoperative G/B developing was analyzed in relation to patient preoperative patterns of upright, mixed, or supine 24-h pH scores. Methods: In this study, 339 patients undergoing fundoplication (278 Nissen and 61 Toupet) were evaluated for preoperative G/B symptoms using a 0 to 10 severity visual analogue scale. Reflux patterns were classified as upright, supine, or mixed according to 24-h pH studies. Results: As compared with preoperative values, 46% of the patients with a preoperative G/B score less than 3 and an upright or mixed reflux pattern had a significant increase in their average G/B score at 2 years (upright, from 0.9 to 4.2; mixed, from 1.1 to 4.1). However, the patients with a supine reflux pattern did not have a statistically significant change (from 2.0 to 2.2; p > 0.05). The patients with established aerophagic tendencies preoperatively (G/B score > 3) showed significant improvement in these symptoms at 2 years across all three reflux patterns (average G/B score, from 7.7 preoperatively to 4.8 at 2 years). There was no gender predisposition, nor was there any difference in the incidence of G/B between complete and partial fundoplication. Conclusions: The pattern of 24-h acid reflux can be predictive of G/B after antireflux surgery. Patients with mild preoperative G/B symptoms (score <3) and upright or mixed patterns of 24-h acid reflux appear to have an increased postoperative risk for chronic G/B as compared with patients who have supine reflux and mild preoperative G/B. Patients with moderate to severe preoperative G/B symptoms (score, 3–10) appear to have a general improvement in G/B symptoms at 2 years after fundoplication.