title: Long-term outcomes following laparoscopic anterior and Nissen fundoplication.
abstract: BACKGROUND
  Limited evidence exists to which operation gives best long-term outcomes for gastro-oesophageal reflux disease. This study aimed to assess long-term symptomatic outcome and satisfaction following laparoscopic anterior (LA) or Nissen fundoplication in a specialist upper gastrointestinal unit.
  
  
  METHODS
  Patients who underwent primary LA or Nissen (LN) fundoplication between May 1994 and June 2010 were identified from a prospectively collected database. DeMeester, modified DeMeester, 'Gastrointestinal Symptom Rating Scale' scores and patient satisfaction were assessed by questionnaire.
  
  
  RESULTS
  A total of 387 patients underwent surgery and 246 patients (65%) completed questionnaires, with 181 LA patients and 65 LN patients. Median follow-up was 83 months for LA and 179 months for LN (P < 0.001). A total of 218/245 (89%) reported major improvement in symptoms and 27 (11%) reported poor outcomes. There was no differences between LA and LN for symptom scores at short (<5 years) or long-term follow-up (>5 years). Women reported significantly higher DeMeester scores and lower satisfaction (P = 0.012). One hundred and eighteen (48%) patients were taking proton pump inhibitors (PPI) at follow-up despite high satisfaction rates.
  
  
  CONCLUSIONS
  LA and LN have similar long-term results with patients reporting high satisfaction levels. Women reported more symptoms and less satisfaction than men. Despite high satisfaction rates a high percentage of patients take PPIs.
authors.affiliation: Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Andrew G N
authors.initials: AG
authors.lastname: Robertson
authors.affiliation: Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Ravi N
authors.initials: RN
authors.lastname: Patel
authors.affiliation: Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Graeme W
authors.initials: GW
authors.lastname: Couper
authors.affiliation: Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: de Beaux
authors.affiliation: Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Paterson-Brown
authors.affiliation: Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lamb
mesh_terms: D000328:Adult; D005260:Female; D018662:Fundoplication / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: fundoplication; general surgery; quality of life; upper gut