title: Predicting patient dissatisfaction following laparoscopic Nissen fundoplication: an analysis of symptoms.
abstract: BACKGROUND
  Nissen fundoplication is a well-established treatment for gastroesophageal reflux disease (GERD) with a high success rate and a long-lasting effect. However, the literature reports that a persistent, small group of patients is not fully satisfied with the outcome. Identifying this patient group preoperatively would prevent disappointment for both patients and surgeon. This has proven difficult since dissatisfaction was related to nondisease-related factors instead of typical symptoms of GERD or the objective findings of investigations. We studied our series of patients who underwent laparoscopic Nissen fundoplication to identify predictors of patient dissatisfaction and the impact of surgery on individual symptoms.
  
  
  METHODS
  All consecutive private patients undergoing Nissen fundoplication were asked to complete a preoperative and postoperative questionnaire concerning symptoms, medication use, and satisfaction. Demographics, investigations, complications, and reinterventions were documented. A standard laparoscopic Nissen fundoplication was performed.
  
  
  RESULTS
  Over an 11-year period 222 patients underwent surgery for GERD. The postoperative response rate to the questionnaire was 77.5 %, with dissatisfaction reported by 12.8 % of the patients. Of these dissatisfied patients, only 13.6 % had proven disease recurrence. Both satisfied and dissatisfied patients presented with an inconsistent pattern of symptoms. None of the preoperative symptoms and investigations or the patient's age and gender was predictive of postoperative dissatisfaction. Only postoperative heartburn, regurgitation, and bloating significantly correlated with patient dissatisfaction.
  
  
  CONCLUSIONS
  Nissen fundoplication has a very high satisfaction rate overall. A small percentage of patients are not fully satisfied and dissatisfaction is associated with reported persistent symptoms and side effects of surgery rather than gender or preoperative symptom pattern, severity of esophagitis, or total 24 h esophageal acid exposure.
authors.affiliation: Department of Surgery, Christchurch Hospital, 2 Riccarton Avenue, Addington, 8011 Christchurch, New Zealand. edwinbeenen@gmail.com
authors.forename: Edwin
authors.initials: E
authors.lastname: Beenen
authors.forename: Paul
authors.initials: P
authors.lastname: Fogarty
authors.forename: Ross H
authors.initials: RH
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000453:epidemiology / Q000523:psychology; D003680:Deglutition Disorders / Q000453:epidemiology / Q000523:psychology; D050782:Esophageal pH Monitoring; D005260:Female; D005414:Flatulence / Q000453:epidemiology / Q000523:psychology; D005544:Forecasting; D018662:Fundoplication / Q000379:methods / Q000523:psychology*; D005764:Gastroesophageal Reflux / Q000523:psychology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000523:psychology*; D057045:Laryngopharyngeal Reflux / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology*; D012008:Recurrence; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D016896:Treatment Outcome; D014839:Vomiting / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult