Prospective analysis of convalescence and early pain after uncomplicated laparoscopic fundoplication.
BACKGROUND
The aim of this study was to define factors that limit a short period of convalescence and to characterize the pain experienced after laparoscopic fundoplication.


METHODS
This prospective study included 60 consecutive patients who underwent uncomplicated laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. Patients were recommended to convalesce for 2 days after operation. Duration of convalescence, dysphagia, fatigue, nausea, vomiting and different pain components were registered daily during the first week and on days 10 and 30 after fundoplication.


RESULTS
Thirty-nine patients took a median of 13 (range 3-41) days off work and 60 stayed away from recreational activity for a median of 4 (range 1-22) days. Pain, fatigue and plans made before operation were the main contributors to prolonged convalescence. Some 30-40 per cent of the patients reported moderate or severe dysphagia during the study period. Fatigue scores were significantly increased for 6 days after surgery (P < 0 . 001). Visceral pain dominated over incisional and shoulder pain throughout the study. At day 30, 17 per cent of the patients reported moderate or severe visceral pain.


CONCLUSIONS
Pain and dysphagia are significant problems after uncomplicated total laparoscopic fundoplication. The time taken off work and away from recreational activity exceeded the recommended 2 days of convalescence, justifying further efforts to optimize early clinical outcome after total laparoscopic fundoplication.
Bisgaard
T
T
Department of Surgical Gastroenterology, H:S Hvidovre Hospital, University of Copenhagen, Hvidovre, University of Copenhagen, Hellerup, Denmark. thuebisgaard@tdcadsl.dk
Støckel
M
M
Klarskov
B
B
Kehlet
H
H
Rosenberg
J
J
D000328:Adult; D000368:Aged; D003289:Convalescence; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data; D016019:Survival Analysis; D014839:Vomiting / Q000209:etiology