title: Patients with upright reflux have less favorable postoperative outcomes after laparoscopic antireflux surgery than those with supine reflux.
abstract: The aim of this study was to compare symptomatic outcomes after laparoscopic antireflux surgery in patients with upright vs. supine reflux. A prospective database was used to assess postoperative clinical outcomes in relation to positional patterns of reflux in 117 patients. Supine reflux was present in 31%, upright in 24%, and the remaining 44% had bipositional reflux. Preoperatively there were no differences in the frequency of typical or atypical symptoms between groups. At a mean follow-up of 18 +/- 11 months postoperatively, there were marked differences in symptoms between groups. Patients with upright reflux noted significantly more heartburn, chest pain, odynophagia, and bloating postoperatively when compared to patients with supine and bipositional reflux (P < 0.05). According to visual analog scales, patients with upright reflux expressed less satisfaction with operative results, ascribing more symptoms to the esophagus and stomach, when compared to those with supine reflux (P < 0.05). Although all patients reported improvement, the extent of the relief from preoperative symptoms was less in patients with upright reflux (P < 0.05). When asked if, in retrospect, they favored operative therapy, the patients with upright reflux were less enthusiastic (P < 0.05). Although antireflux surgery eliminates reflux in nearly all patients, postoperative symptomatic outcome is related to the preoperative pattern of reflux. Although all patients showed symptomatic improvement, the extent of that improvement was significantly less in patients with upright reflux. These patients should be carefully counseled preoperatively regarding expected symptomatic outcomes.
authors.affiliation: Department of Surgery, Washington University School of Medicine, WUMS Box 8109, 660 South Euclid, St. Louis, MO 63110, USA. winslowe@msnotes.wustl.edu
authors.forename: Emily R
authors.initials: ER
authors.lastname: Winslow
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Frisella
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Soper
authors.forename: Ray E
authors.initials: RE
authors.lastname: Clouse
authors.forename: Mary E
authors.initials: ME
authors.lastname: Klingensmith
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D011336:Probability; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016683:Supine Position; D016896:Treatment Outcome