Clinical results of laparoscopic fundoplication at ten years after surgery.
BACKGROUND
Several studies have demonstrated laparoscopic antireflux surgery (LAS) for the treatment of gastroesophageal reflux disease (GERD) to be efficient at short- and midterm follow-up evaluations. The aim of this study was to evaluate the results for LAS 10 years after surgery.


METHODS
The 100 consecutive patients who underwent LAS by a single surgeon in 1993 were entered into a prospective database. Nissen fundoplication was performed for 68 patients, and partial posterior fundoplication (modified Toupet procedure) was performed for 32 patients. Evaluations of the outcome were made 5 and 10 years after surgery. A structured symptom questionnaire and upper gastrointestinal barium series were used at 5 years. The same questionnaire and an added quality-of-life questionnaire (the Gastrointestinal Quality of Life Index [GIQLI]) were used at 10 years.


RESULTS
Seven patients died of unrelated causes during the 10-year period. Four patients underwent revision surgery: one patient for persistent dysphagia and three patients for recurrent reflux symptoms. Three patients were lost to any follow-up study. At 5 years, 93% of the patients were free of significant reflux symptoms. At 10 years, 89.5% of the patients still were free of significant reflux (93.3% after Nissen, 81.8% after Toupet). Major side effects (flatulence and abdominal distension) were related to "wind" problems. The GIQLI scores at 10 years were significantly better than the preoperative scores of the patients under medical therapy with proton pump inhibitors.


CONCLUSIONS
Elimination of GERD symptoms improved quality of life and eliminated the need for daily acid suppression in most patients. These results, apparent 5 years after the operation, still were valid at 10 years.
Dallemagne
B
B
Department of Digestive Surgery, CHC-Les Cliniques Saint Joseph, Belgium. bernard.dallemagne@skynet.be
Weerts
J
J
Markiewicz
S
S
Dewandre
J-M
JM
Wahlen
C
C
Monami
B
B
Jehaes
C
C
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D001464:Barium / Q000008:administration & dosage; D002648:Child; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D006356:Heartburn / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors; D011788:Quality of Life; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors; D001464:Barium