Long-term outcomes of quality of life after laparoscopic Nissen fundoplication.
OBJECTIVE
Several years after the surgery, the results obtained with the operation by Nissen laparoscopy in the treatment of GERD are not sufficiently clarified. Some series reveal good results at short-term; however, the results obtained at long-term are still little known. The aim of our research is to evaluate the results regarding quality of life in patients operated with the laparoscopic Nissen technique.


METHODS
We carried out a study of 143 laparoscopic Nissen's, operated from January 1995 to August 2004. There were 60 men and 83 women with an average age of 49.9 years (18-75); the average follow-up was of 5.42 years (2-11 years). There was no operative mortality; morbidity was of 8.4% and the rate of conversion 2.79%. The analysis of quality of life was made according to our personal questionnaire, consisting of a group of symptoms (23 items) and another related to physical, emotional and psycho-social activities (9 items) duly validated in healthy individuals. We recorded the values corresponding to the sum of the two mentioned groups before and after surgery, referred to in the pre and post-operative according to answers based on an increasing scale of values (from 0 to 3). The higher the score, the higher is the quality of life. In the statistical analysis we resorted to parametric tests (t Student and Anova) and non-parametric (McNemar and Cochran); Values of p < 0.05 were considered significant.


RESULTS
The overall analysis in increasing values on a scale of 0 to 3 showed a clear significant improvement of the quality of life after the surgery (+17.50 p < 0.001), although never reaching the values recorded in healthy individuals. Such improvement was more evident in the symptoms group than in the one corresponding to physical, emotional and psycho-social activities (+16.11 vs +2.27, p < 0.001). Among the specific reflux symptoms the ones that benefited most from the surgery were: heartburn (+2.203), regurgitation (+1.95), gastralgia (+1.23) and need to eat slowly (+1.50). Though significant, less satisfactory results were registered in the gas bloating (+0.40), fullness (+0.62) and incapacity to belch (+0.74). In 13.3% it was necessary to resort to medication. In 92.3% the results were considered very good or good and 7.7% bad. There was not any correlation between the quality of life and the different factors included in those operated on: age, sex, operative period, esophagitis and diaphragmatic hernia.


CONCLUSIONS
The Nissen operation by laparoscopy is an excellent option in the treatment of GERD. After it takes place there is a clear improvement in the quality of life of these people, especially in relation to the symptoms typical of GERD; it is, however, less evident in relation to fullness and abdominal bloating.
Teixeira
J P Araújo
JP
Hospital S. João, Department of Surgery, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. jpat@netcabo.pt
Mosquera
V
V
Flores
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000523:psychology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome