title: Reflux, dysphagia, and gas bloat after laparoscopic fundoplication in patients with incidentally discovered hiatal hernia and in a control group.
abstract: 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.
authors.affiliation: Clinic and Policlinic of Digestive Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland. frederic.triponez@hcuge.ch
authors.forename: Frederic
authors.initials: F
authors.lastname: Triponez
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Dumonceau
authors.forename: Dan
authors.initials: D
authors.lastname: Azagury
authors.forename: Francesco
authors.initials: F
authors.lastname: Volonte
authors.forename: Karem
authors.initials: K
authors.lastname: Slim
authors.forename: Bernadette
authors.initials: B
authors.lastname: Mermillod
authors.forename: Olivier
authors.initials: O
authors.lastname: Huber
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: 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
chemical_list: D005740:Gases