Reflux, dysphagia, and gas bloat after laparoscopic fundoplication in patients with incidentally discovered hiatal hernia and in a control group.
BACKGROUND
Laparoscopic fundoplication effectively controls reflux symptoms in patients with gastroesophageal reflux disease (GERD). However, symptom relapse and side effects, including dysphagia and gas bloat, may develop after surgery. The aim of the study was to assess these symptoms in patients who underwent laparoscopic fundoplication, as well as in control subjects and patients with hiatal hernia.


METHODS
A standardized, validated questionnaire on reflux, dysphagia, and gas bloat was filled out by 115 patients with a follow-up of 1 to 7 years after laparoscopic fundoplication, as well as by 105 subjects with an incidentally discovered hiatal hernia and 238 control subjects.


RESULTS
Patients who underwent fundoplication had better reflux scores than patients with hiatal hernia ( P = .0001) and similar scores to control subjects ( P = .11). They also had significantly more dysphagia and gas bloat than patients with hiatal hernia and controls ( P < .005 for all comparisons). Gas bloat and dysphagia were more severe in hiatal hernia patients than in controls ( P < 0.005). After fundoplication, the 25% of the patients with the shortest follow-up (1.5 +/- 0.2 years) and the 25% patients with the longest follow-up (5.8 +/- 0.6 years) had similar reflux, dysphagia, and gas bloat scores ( P = .43, .82, and .85, respectively).


CONCLUSIONS
In patients with severe GERD, laparoscopic fundoplication decreases reflux symptoms to levels found in control subjects. These results appear to be stable over time. However, patients who underwent fundoplication experience more dysphagia and gas bloat than controls and patients with hiatal hernia-symptoms that should be seen as a side effect of the procedure and of GERD itself.
Triponez
Frederic
F
Clinic and Policlinic of Digestive Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland. frederic.triponez@hcuge.ch
Dumonceau
Jean-Marc
JM
Azagury
Dan
D
Volonte
Francesco
F
Slim
Karem
K
Mermillod
Bernadette
B
Huber
Olivier
O
Morel
Philippe
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005740:Gases; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D011795:Surveys and Questionnaires
D005740:Gases