Outcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results.
OBJECTIVE
Preoperative 24-hour pH testing is controversial in surgical patients who have symptomatic gastroesophageal reflux disease (GERD) and endoscopic evidence of esophagitis. The objective of this study was to compare the clinical outcomes of Nissen fundoplication for symptomatic reflux between patients with normal and abnormal preoperative pH testing.


METHODS
Patients were selected from a prospective database of patients who underwent laparoscopic esophageal procedures between January 1997 and December 2001 at our institution. Only patients having typical symptoms of GERD (heartburn and/or reflux), preoperative pH testing, manometry, and endoscopy and who had at least 6 months of post-operative follow-up were included in the study. Fifteen patients had normal preoperative DeMeester scores (DMS) (median 11.4, range 3.3 to 14.7). These were compared with 208 consecutive patients having abnormal preoperative DMS (median 49.6, range 15.2 to 250). Logistic regression modeling was performed to identify variables significant for poor outcome. Differences between means were tested using appropriate parametric or nonparametric tests.


RESULTS
There were no statistically significant differences in demographics, preoperative symptom score (mean 2.9 +/- 1.1 vs. 3.1 +/- 0.68, P = 0.30), or preoperative grade of esophagitis (P = 0.37) between the 2 groups. After a median follow-up of 8.8 months (range 6 to 36), 6 (40%) of the patients having normal preoperative DMS and 17 (8.1%) of the patients having abnormal preoperative DMS continued to have typical GERD symptoms (P <0.01, B error = 0.02). The most significant factor for poor outcome in the regression model was normal preoperative pH (odds ratio 9.02, P <0.01).


CONCLUSIONS
Symptomatic GERD patients with normal preoperative 24-hour pH test results have significantly worse subjective outcomes after Nissen fundoplication compared with patients having abnormal preoperative pH test results. To minimize poor symptomatic outcomes after antireflux surgery, a policy of routine preoperative pH testing is advised.
Khajanchee
Yashodhan S
YS
Department of Minimally Invasive Surgery, Legacy Health System, 1040 N.W. 22nd St., Suite 560, Portland, OR 97210, USA.
Hong
Dennis
D
Hansen
Paul D
PD
Swanström
Lee L
LL
D000368:Aged; D000465:Algorithms; D001835:Body Weight; D003663:Decision Trees; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods; D005744:Gastric Acid / Q000737:chemistry*; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016015:Logistic Models; D008297:Male; D008365:Manometry; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome