title: Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease. Long-term quality-of-life assessment and surgical outcome.
abstract: BACKGROUND
  It is known that laparoscopic antireflux surgery (LARS) can achieve an excellent surgical outcome including quality of life improvement in patients with erosive gastroesophageal reflux disease (GERD; EGD-positive). Less is known about the long-term surgical outcome in GERD patients who have no evidence of esophagitis (EGD-negative) before surgery. The aim of this study was to evaluate the surgical outcome in a well-selected group of EGD-negative patients compared to that of EGD-positive patients.
  
  
  METHODS
  From a large sample of more than 500 patients who underwent LARS, 89 EGD-negative patients (mean age, 51 +/- 6 years; 56 males) were treated surgically because of persistent reflux-related symptoms despite medical therapy. In all cases, preoperative 24-h pH monitoring showed pathological values. To perform a comparative analysis, a matched sample of EGD-positive patients (mean age, 54 +/- 10 years; 58 males) was selected from the database. Surgical outcome included for all patients objective data (e.g., manometry and pH data and endoscopy), quality of life evaluation [Gastrointestinal Quality of Life Index (GIQLI)] symptom evaluation, as well as patients' satisfaction with surgery. The data of a complete 5-year follow-up are available.
  
  
  RESULTS
  There were no significant differences in symptomatic improvement, percentage of persistent surgical side-effects, or objective parameters. In general, patients' satisfaction with surgery was comparable in both groups: 95% rated long-term outcome as excellent or good and would undergo surgical treatment again if necessary, respectively. Quality of life improvement was significantly better (p < 0.05) in the EGD-negative group because of the fact that GIQLI was more impaired before surgery (preoperative GIQLI, 81.7 +/- 11.6 points/EGD-negative vs 93.8 +/- 10.3 points/EGD-positive). Five years after surgery, GIQLI in both groups (121.2 +/- 8.5 for EGD-negative vs 120.9 +/- 7.3 for EGD-positive) showed comparable values to healthy controls (122.6 +/- 8.5).
  
  
  CONCLUSIONS
  We suggest that LARS is an excellent treatment option for well-selected patients with persistent GERD-related symptoms who have no endoscopic evidence of esophagitis.
authors.affiliation: Division of Clinical Psychology, Public Hospital of Zell am See, A-5700 Zell am See, Austria. thomas.kamolz@kh-zellamsee.at
authors.forename: T
authors.initials: T
authors.lastname: Kamolz
authors.forename: F A
authors.initials: FA
authors.lastname: Granderath
authors.forename: U M
authors.initials: UM
authors.lastname: Schweiger
authors.forename: R
authors.initials: R
authors.lastname: Pointner
mesh_terms: D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002637:Chest Pain / Q000209:etiology; D003131:Combined Modality Therapy; D004942:Esophagitis, Peptic / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents