title: Medical comorbidities should not deter the application of laparoscopic fundoplication.
abstract: BACKGROUND
  Laparoscopic Nissen fundoplication offers significant improvement in gastroesophageal reflux disease (GERD) symptom severity and frequency. This study was undertaken to determine the impact of preoperative medical comorbidities on the outcome and satisfaction of patients undergoing fundoplication for GERD.
  
  
  METHODS
  Prior to fundoplication, patients underwent esophageal motility testing and 24-h pH monitoring. Before and after fundoplication, the frequency and severity of reflux symptoms were scored using a Likert scale. Medical comorbidities were classified by organ systems, and patients were assigned points corresponding to the number of medical comorbidities they had. In addition, all patients were assigned Charlson comorbidity index (CCI) scores according to the medical comorbidities they had. A medical comorbidity was defined as a preexisting medical condition, not related to GERD, for which the patient was receiving treatment. Analyses were then conducted to determine the impact of medical comorbidities as well as CCI score on overall outcome, symptom improvement, and satisfaction.
  
  
  RESULTS
  Six hundred and ninety-six patients underwent fundoplication: 538 patients had no medical comorbidities and 158 patients had one or more medical comorbidities. Preoperatively, there were no differences in symptom severity and frequency scores between patients with or without medical comorbidities. Postoperatively, all patients had improvement in their symptom severity and frequency scores. There were no differences in postoperative symptom scores between the patients with medical comorbidities and those without. The majority of patients were satisfied with their overall outcome; there was no relationship between the number of medical comorbidities and satisfaction scores. These findings were mirrored when patients' CCI scores were compared with satisfaction, overall outcome, and symptom improvement.
  
  
  CONCLUSIONS
  These results promote further application of laparoscopic Nissen fundoplication, even for patients with medical comorbidities.
authors.affiliation: University of South Florida and Tampa General Hospital Digestive Disorders Center, Tampa, FL, USA.
authors.forename: Farhaad
authors.initials: F
authors.lastname: Golkar
authors.forename: Connor
authors.initials: C
authors.lastname: Morton
authors.forename: Sharona
authors.initials: S
authors.lastname: Ross
authors.forename: Michelle
authors.initials: M
authors.lastname: Vice
authors.forename: Demitri
authors.initials: D
authors.lastname: Arnaoutakis
authors.forename: Sujat
authors.initials: S
authors.lastname: Dahal
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hernandez
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005769:Gastrointestinal Motility / Q000502:physiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications*; D009422:Nervous System Diseases / Q000150:complications*; D017060:Patient Satisfaction; D011312:Pressure; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome