title: Bowel dysfunction after laparoscopic antireflux surgery: incidence, severity, and clinical course.
abstract: OBJECTIVE
  To evaluate the incidence, severity, and clinical course of postoperative bowel dysfunction, primarily diarrhea, after laparoscopic antireflux surgery.
  
  
  METHODS
  Patients who underwent laparoscopic antireflux surgery during January to December 1998 responded to a questionnaire about pre-existing and postoperative bowel symptoms, which included questions about the type of bowel dysfunction (diarrhea, abdominal pain, bloating, constipation), onset in relation to surgery, frequency, severity, duration, use of medical resources or diagnostic evaluations, and treatment outcome.
  
  
  RESULTS
  Of the 109 patients who underwent laparoscopic antireflux surgery at our center during the study, 84 (77%) completed the survey. Thirty-six (43%) had no bowel dysfunction before or after surgery, whereas 29 (35%) had pre-existing bowel dysfunction. New bowel symptoms developed postoperatively in 30 patients (36%), including bloating in 16 (19%) and diarrhea in 15 (18%). Two thirds of the patients with new diarrhea developed it within 6 weeks after surgery. The severity of the diarrhea ranged from mild to debilitating; 4 had fecal incontinence. Most patients (13/15) with diarrhea had symptoms for > or =2 years following surgery. No patient was hospitalized, and only 2 patients reported temporary work loss.
  
  
  CONCLUSIONS
  Postoperative bowel dysfunction, namely diarrhea, is an important adverse effect of antireflux surgery. Awareness of this complication should lead to prompt recognition, effective management, and reduction in anxiety.
authors.affiliation: Department of Surgery, Mayo Clinic, Jacksonville, Florida 32224, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Klaus
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Hinder
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: DeVault
authors.forename: Sami R
authors.initials: SR
authors.lastname: Achem
mesh_terms: D000328:Adult; D000368:Aged; D003967:Diarrhea / Q000209:etiology*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012720:Severity of Illness Index