title: Causes of dissatisfaction after laparoscopic fundoplication: the impact of new symptoms, recurrent symptoms, and the patient experience.
abstract: BACKGROUND
  Although laparoscopic fundoplication effectively alleviates gastroesophageal reflux disease (GERD) in the great majority of patients, some patients remain dissatisfied after the operation. This study was undertaken to report the outcomes of these patients and to determine the causes of dissatisfaction after laparoscopic fundoplication.
  
  
  METHODS
  All patients undergoing laparoscopic fundoplication in the authors' series from 1992 to 2010 were evaluated for frequency and severity of symptoms before and after laparoscopic fundoplication, and their experiences were graded from "very satisfying" to "very unsatisfying." Objective outcomes were determined by endoscopy, barium swallow, and pH monitoring. Primary complaints were derived from postoperative surveys. Median data are reported.
  
  
  RESULTS
  Of the 1,063 patients undergoing laparoscopic fundoplication, 101 patients reported dissatisfaction after the procedure. The follow-up period was 33 months. The dissatisfied patients (n = 101) were more likely than the satisfied patients to have postoperative complications (9 vs 4 %; p < 0.05) and to have undergone a prior fundoplication (22 vs 11 %; p < 0.05). For the dissatisfied patients, heartburn decreased in frequency and severity after fundoplication (p < 0.05) but remained notable. Also for the dissatisfied patients, new symptoms (gas bloat/dysphagia) were the most prominent postoperative complaint (59 %), followed by symptom recurrence (23 %), symptom persistence (4 %), and the overall experience (14 %). Primary complaints of new symptoms were most common within the first year of follow-up assessment and less frequent thereafter. Primary complaints of recurrent symptoms generally occurred more than 1 year after fundoplication.
  
  
  CONCLUSIONS
  Dissatisfaction is uncommon after laparoscopic fundoplication. New symptoms, such as dysphagia and gas/bloating, are primary causes of dissatisfaction despite general reflux alleviation among these patients. New symptoms occur sooner after fundoplication than recurrent symptoms and may become less common with time.
authors.affiliation: Advanced Laparoscopic and Robotic HPB and Foregut Surgery, Florida Hospital Tampa, 3000 Medical Park Drive, Suite 310, Tampa, FL 33613, USA.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Humphries
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Hernandez
authors.forename: Whalen
authors.initials: W
authors.lastname: Clark
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luberice
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D015897:Comorbidity; D003287:Contrast Media; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology; D004884:Eructation / Q000453:epidemiology / Q000209:etiology; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods / Q000523:psychology*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000523:psychology / Q000601:surgery*; D005773:Gastroscopy; D006551:Hernia, Hiatal / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate