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Quality of Life Following Laparoscopic Anterior 90° Versus Nissen Fundoplication: Results from a Multicenter Randomized Trial

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Abstract

Background

The short-term clinical outcomes from a multicenter prospective randomized trial of laparoscopic Nissen versus anterior 90° partial fundoplication have been reported previously. These demonstrated a high level of satisfaction with the overall outcome following anterior 90° fundoplication. However, the results of postoperative objective tests and specific clinical symptoms are not always consistent with an individual patient’s functional status and general well being following surgery, and quality of life (QOL) is also an important outcome to consider following surgery for reflux. Hence, QOL information was collected in this trial to investigate the hypothesis: improvements in QOL following laparoscopic antireflux surgery are greater after anterior 90° partial fundoplication than after Nissen fundoplication.

Methods

Patients undergoing a laparoscopic fundoplication for gastro-esophageal reflux at one of nine university teaching hospitals in six major cities in Australia and New Zealand were randomized to undergo either laparoscopic Nissen or anterior 90° partial fundoplication. Quality of life before and after surgery was assessed using validated questionnaires – the Short Form 36 general health questionnaire (SF36) and an Illness Behavior Questionnaire (IBQ). Patients were asked to complete these questionnaires preoperatively and at 3, 6, 12 and 24 months postoperatively.

Results

One hundred and twelve patients were randomized to undergo a Nissen fundoplication (52) or a 90° anterior fundoplication (60). Patients who underwent anterior fundoplication reported significant improvements in eight of the nine SF36 scales compared to four of the nine following a Nissen fundoplication. The majority of these improvements occurred early in the postoperative period. With respect to the illness behavior data, there were no significant differences between the two procedures. Both groups had a significant improvement in disease conviction scores at all time points compared to their preoperative scores.

Conclusions

Patients undergoing laparoscopic anterior 90° partial fundoplication reported more QOL improvements in the early postoperative period than patients undergoing a Nissen fundoplication. However, the QOL outcome for both procedures was similar at later follow-up.

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Acknowledgments

The authors wish to acknowledge the assistance of Ms. N. Ascott and Ms. T. Ellis for their invaluable organizational and logistical support. The authors also wish to acknowledge financial support for this study from the National Heath and Medical Research Council of Australia and from the Astra Upper Gastrointestinal Research Grant (through Upper Gastrointestinal Section of the Royal Australasian College of Surgeons).

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Authors and Affiliations

  1. Flinders University of South Australia, Adelaide, SA, Australia

    Sean A. Woodcock MS, FRCS, David I. Watson MD, FRACS, Justin R. Bessell MD, FRACS & John A. Windsor MD, FRACS (for the International Society for Diseases of the Esophagus – Australasian Section)

  2. University of Adelaide, Adelaide, SA, Australia

    Carolyn Lally RN, Peter G. Devitt MS, FRACS & Glyn G. Jamieson MS, FRCS, FRACS

  3. University of Western Australia, Crawley, WA, Australia

    Stephen Archer PhD, FRACS, Graham L. Cullingford MB, BS, FRACS & David R. Fletcher MD, FRACS

  4. University of Auckland, Auckland, New Zealand

    Michael Booth MB, BS, FRACS

  5. Melbourne University, Melbourne, VIC, Australia

    Richard Cade MB, BS, FRACS, James Hurley MB, BS, FRACS & George Kiroff MS FRACS

  6. University of Sydney, Sydney, NSW, Australia

    Christopher J. Martin MSc, FRACS

  7. University of Queensland, Brisbane, QLD, Australia

    Ian J. G. Martin MB, BS, FRACS & Leslie K. Nathanson MB, ChB, FRACS

  8. Department of Surgery, Flinders University of South Australia, Flinders Medical Center, Room 3D211, Bedford Park, SA, 5042, Australia

    David I. Watson MD, FRACS

Authors
  1. Sean A. Woodcock MS, FRCS
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  2. David I. Watson MD, FRACS
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  3. Carolyn Lally RN
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  4. Stephen Archer PhD, FRACS
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  5. Justin R. Bessell MD, FRACS
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  6. Michael Booth MB, BS, FRACS
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  7. Richard Cade MB, BS, FRACS
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  8. Graham L. Cullingford MB, BS, FRACS
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  9. Peter G. Devitt MS, FRACS
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  10. David R. Fletcher MD, FRACS
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  11. James Hurley MB, BS, FRACS
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  12. Glyn G. Jamieson MS, FRCS, FRACS
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  13. George Kiroff MS FRACS
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  14. Christopher J. Martin MSc, FRACS
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  15. Ian J. G. Martin MB, BS, FRACS
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  16. Leslie K. Nathanson MB, ChB, FRACS
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  17. John A. Windsor MD, FRACS
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Corresponding author

Correspondence to David I. Watson MD, FRACS.

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Woodcock, S.A., Watson, D.I., Lally, C. et al. Quality of Life Following Laparoscopic Anterior 90° Versus Nissen Fundoplication: Results from a Multicenter Randomized Trial. World J. Surg. 30, 1856–1863 (2006). https://doi.org/10.1007/s00268-005-0623-7

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  • DOI: https://doi.org/10.1007/s00268-005-0623-7

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