title: Combined transabdominal gastroplasty and fundoplication for shortened esophagus: impact on reflux-related and overall quality of life.
abstract: BACKGROUND
  Transabdominal gastroplasty for shortened esophagus at the time of fundoplication results in a segment of aperistaltic, acid-secreting neoesophagus above the fundoplication. We hypothesized that transabdominal gastroplasty impairs quality of life (QOL).
  
  
  METHODS
  This was a matched paired analysis with retrospective chart review and follow-up questionnaire of 116 patients undergoing transabdominal fundoplication with gastroplasty with 116 matched controls undergoing transabdominal fundoplication alone from January 1997 to June 2005. Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and Quality Of Life in Reflux And Dyspepsia (QOLRAD) instruments were used to measure overall and reflux-related QOL. Overall response rate was 75%; including 65 matched pairs used for long-term follow-up and QOL analysis.
  
  
  RESULTS
  Groups were similar in age, sex, duration of hospitalization, and complications (p > 0.05). Gastroplasty patients had larger hiatal hernias and were more likely to have undergone a previous fundoplication (p < 0.01). No perioperative deaths or major morbidity occurred in 18% of both groups. Survey respondents were older than nonrespondents (p < 0.01). Complications did not impact response rates (p = 0.11). Median follow-up was 14 months in the gastroplasty group and 17 months in controls (p = 0.02). The groups had similar scores on the SF-36 and QOLRAD (p > 0.05) and similar overall frequency of patient satisfaction, perceived health status, and self-reported symptoms of reflux, dysphagia, bloating, diarrhea, and excessive flatus (p > 0.05). Control patients were more likely to require rehospitalization or reinterventions (p = 0.04).
  
  
  CONCLUSIONS
  Transabdominal gastroplasty and fundoplication for shortened esophagus is safe and results in similar overall and reflux-related QOL compared with fundoplication alone.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Scott G
authors.initials: SG
authors.lastname: Houghton
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.forename: Sunni A
authors.initials: SA
authors.lastname: Barnes
authors.forename: Peter C
authors.initials: PC
authors.lastname: Pairolero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004415:Dyspepsia / Q000209:etiology; D004935:Esophageal Diseases / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology*; D015391:Gastroplasty / Q000379:methods*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies