title: 20 years later: laparoscopic fundoplication durability.
abstract: BACKGROUND
  Laparoscopic surgery for gastrointestinal reflux disease was introduced in 1991. Early safety, efficacy, and 5-10-year durability have been amply documented, but long-term patient outcomes have been criticized. This study presents 20-year outcomes after laparoscopic fundoplication (LF) in a consecutive patient cohort.
  
  
  METHODS
  Patients who underwent primary LF procedures for gastroesophageal reflux disease (GERD) were identified from a prospectively collected IRB-approved database (1991-1995). A phone symptom questionnaire was administered using a 5-point validated GERD scoring system (heartburn, regurgitation, and dysphagia). Symptomatic success was defined by a lack of surgical re-intervention and a low symptom score.
  
  
  RESULTS
  One-hundred and ninety-three patients were identified during the time period. Fifty-one patients completed the survey (100 lost to follow-up, 40 deceased, 2 declined to answer). Respondents had a median follow-up of 19.7 years. Overall, 38/51 (74.5%) of patients reported complete control of heartburn and regurgitation. Ten patients reported only occasional heartburn. Eight of fifty-one (16%) reported daily dysphagia, and 22/51 (43%) of respondents were using proton pump inhibitors at the time of telephone interview. Nine of fifty-one (18%) underwent revision of the original surgery which did not negatively impact the satisfaction rating, with 8/9 (89%) of these patients reporting the highest satisfaction rating. Overall, 46/51 (90%) were satisfied with their choice of surgery.
  
  
  CONCLUSIONS
  Long-term results from the early experience with LF are excellent with 94% of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up. However, 18% required surgical revision surgery to maintain their results. There is a relatively high rate of daily dysphagia but 90% of patients are happy to have had LF.
authors.affiliation: Foundation for Surgical Innovation and Education, Portland, OR, USA, benny@spu.edu.
authors.forename: Ben
authors.initials: B
authors.lastname: Robinson
authors.forename: Christy M
authors.initials: CM
authors.lastname: Dunst
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sharata
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanstrom
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005544:Forecasting; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016896:Treatment Outcome