Laparoscopic Surgery Staves Off Severe GERD Symptoms Over Long Haul
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Laparoscopic anti-reflux surgery has proved to be a highly effective and long-lasting treatment for severe gastroesophageal reflux disease (GERD).
At least five years after undergoing one of three types of laparoscopic fundoplication, 93% of the 1,340 severe GERD patients said they were highly satisfied with the operation, French investigators wrote in the October issue of Archives of Surgery.
A research team led by Patrick Pessaux, M.D., a gastrointestinal surgeon at the University Hospital here, noted that several studies have shown that laparoscopic surgery for GERD is safe and effective. However, only a few studies have provided long-term follow-up data for this treatment.
Now, the authors wrote, their retrospective multicenter study confirms that this procedure is not only effective, but also long-lasting. The researchers pointed to a 10% recurrence rate for a follow-up of seven years as evidence of the surgery’s durability.
Intraoperative and postoperative complications among the 1,340 patients in the French study were quite low, 2.1% and 2.6% respectively. Only 4.4% of patients required additional surgery, the surgeons reported.
The overall symptom recurrence rate was also low at about 10% (136 patients), with 9% of that group resuming use of antisecretory medication.
The investigators also found no major difference in the patients’ satisfaction levels with the three procedures: complete fundoplication, partial posterior fundoplication, and partial anterior fundoplication.
The study included 815 men and 525 women who underwent one of three types of laparoscopic fundoplication between January 1992 and December 1998 to treat GERD symptoms. The patients’ average age was 49, and the average duration of GERD symptoms was 6.8 years. All the patients had used medical therapy for a mean of 1.9 years.
The procedures were performed at 31 hospital centers. A total of 711 patients underwent complete fundoplication, 599 had partial posterior fundoplication, and 70, partial anterior fundoplication. The mean post-operative stay was 5.0 ± 3.2 days.
Questionnaires were mailed to the patients in which they were asked about their gastrointestinal symptoms after the procedure, the actions taken to treat their symptoms, and their satisfaction with their surgery. The mean follow-up was 7.1 years ± 1.5.
No deaths occurred in the study group. The conversion rate was 8.3%, and there were 29 intraoperative complications although not all needed a conversion, Dr. Pessaux and colleagues reported.
More than 19% of the group had adverse effects from the surgery with dysphagia and gas bloating the most common. Still, these patients reported that such side effects were minor compared with the improvement in their symptoms, the researchers wrote.
Fifty-nine patients (4.4%) required additional surgery for a total of 63 interventions. More than half (32) of these procedures were done laparoscopically.
The most common causes for additional procedures were recurrent reflux (31 patients) because the wrap came undone, repair of a paraesophageal hiatus hernia (12), and dysphagia (11). Two other procedures were for intestinal obstruction; one was for an incisional hernia; another one for an abdominal abscess, and one for gastroparesis.
Less than half the patients (43.1%) had transient post-op dysphagia during the first three months after surgery, but for many of these patients, the dysphagia improved in six weeks and did not require intervention.
Overall, all three types of laparoscopic surgery were well tolerated, with the majority of patients reporting very high levels of satisfaction.
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