title: Efficacy of laparoscopic fundoplication in controlling pulmonary symptoms associated with gastroesophageal reflux disease.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD)-induced pulmonary symptoms (PS) can be difficult to control. The effectiveness of laparoscopic fundoplication (LF) in controlling PS among patients with medically recalcitrant GERD is poorly documented. We evaluated our results in controlling important PS in patients with GERD undergoing LF.
  
  
  METHODS
  Seventy-four patients (28 men, 46 women) were identified with clinically important PS from a prospective cohort of 155 patients undergoing elective LF for recalcitrant GERD. Median age was 52.5 years (range, 29-84 years). Sixty-seven (91%) patients were taking proton pump inhibitors at the time of operation. Quality of life by using the SF36 physical (PCS) and mental (MCS) component summary scores (normal, 50) and heartburn severity by using the health-related quality of life (HRQOL) (best score, 0; worst score, 45) were measured.
  
  
  RESULTS
  All 74 patients with PS survived operation, and minor morbidity occurred in 5 (7%) patients. Median hospital stay was 2 days (range, 1-6 days), and return to normal activity was seen at 2.2 weeks (range, 1-8 weeks). Median follow-up was 12 months. PS were improved significantly (P < .01) for hoarseness (62% to 17.6%), bronchospasm (60% to 9.5%), and aspiration (22% to 1.4%). Before LF, 11 (14.9%) patients required bronchodilators or oral steroids. Postoperatively such therapy was required in only 3 (4.2%) patients (P = .019), with no patient requiring oral steroids. Patients with poorer control of their GERD on the basis of high HRQOL scores had significantly more PS after operation.
  
  
  CONCLUSIONS
  A significant number of patients with medically recalcitrant GERD (46% from our prospective database) have important PS. LF can improve PS, decrease requirement for pulmonary medications, as well as improve typical reflux symptoms and quality of life.
authors.affiliation: Department of Cardiothoracic Surgery, Boston University, Massachusetts, USA. hiran.fernando@bmc.org
authors.forename: Hiran C
authors.initials: HC
authors.lastname: Fernando
authors.forename: Amgad
authors.initials: A
authors.lastname: El-Sherif
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
authors.forename: Percival O
authors.initials: PO
authors.lastname: Buenaventura
authors.forename: John M
authors.initials: JM
authors.lastname: Close
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008171:Lung Diseases / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors