title: Postoperative symptoms and failure after antireflux surgery.
abstract: BACKGROUND
  Outcomes in patients having surgery for gastroesophageal reflux disease are most commonly determined by symptomatic assessment. Objective testing is usually reserved for symptomatic patients.
  
  
  OBJECTIVE
  To evaluate the relationship between symptomatic and objective outcomes after antireflux surgery.
  
  
  METHODS
  Retrospective analysis of prospectively collected data.
  
  
  METHODS
  A tertiary care teaching hospital with a comprehensive esophageal physiology laboratory.
  
  
  METHODS
  A 360 degrees (Nissen) fundoplication or a 270 degrees (Toupet) posterior fundoplication was performed based on esophageal motility. Twenty-four-hour pH monitoring was used as a gold standard for assessing postoperative acid reflux.
  
  
  METHODS
  Two hundred nine consecutive patients with preoperative and postoperative symptomatic and objective testing performed between January 1, 1996, and June 15, 2001.
  
  
  METHODS
  Data on preoperative and postoperative symptoms, DeMeester scores, and esophageal motility were prospectively collected. Objective testing was performed after at least 6 months.
  
  
  RESULTS
  The preoperative median DeMeester score was 50.0 (interquartile [IQ] range, 30.3-87.0). One hundred eighty patients had a Nissen and 29 patients had a Toupet fundoplication. After a median postoperative interval of 7.7 months (IQ range, 6.7-9.5 months), 174 patients (83.3%) had normal DeMeester scores (median, 2.2; IQ range, 0.8-5.0; P<.001). Of 58 patients (27.7%) who had reflux symptoms after surgery, only 17 (29.3%) had abnormal DeMeester scores (median, 36.9; IQ range, 748.4-20.0; P =.001). Eighteen (11.9%) of the 151 asymptomatic patients had abnormal DeMeester scores (median, 32.5; IQ range, 22.2-57.5; P =.006).
  
  
  CONCLUSIONS
  There is poor correlation between postoperative reflux symptoms and actual reflux (abnormal DeMeester scores). Surgeons must be careful to define their terms when reporting success or failure rates after antireflux surgery. Routine use of medical therapy for suppressing postoperative gastroesophageal reflux disease symptoms is not supported by these data, and postoperative therapy should be based on objective testing only.
authors.affiliation: Department of Minimally Invasive Surgery, Legacy Health System, 501 N Graham, Suite 120, Portland, OR 97227, USA. lswanstr@lhs.org
authors.forename: Yashodhan S
authors.initials: YS
authors.lastname: Khajanchee
authors.forename: Robert W
authors.initials: RW
authors.lastname: O'Rourke
authors.forename: Barbara
authors.initials: B
authors.lastname: Lockhart
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Patterson
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanstrom
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D017211:Treatment Failure