title: Laparoscopic redo fundoplication improves disease-specific and global quality of life following failed laparoscopic or open fundoplication.
abstract: Laparoscopic fundoplication is associated with failure rates of up to 30% and redo operation rates of 5-8%. Redo fundoplication improves patient symptoms, but its impact on patient quality of life remains unclear. We hypothesized that laparoscopic redo fundoplication improves disease-specific and global quality of life in patients with recurrent symptoms following failed laparoscopic or open fundoplication.
  
  
  
  Data for all patients undergoing a redo fundoplication between August 2009 and June 2014 were collected prospectively. Reflux symptoms and quality of life were assessed using the Gastroesophageal Reflux Symptom Scale (GERSS), the Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL), and the global quality of life Short Form-36 (SF-36) questionnaires obtained at 4 weeks and 16 months post-operatively.
  
  
  
  Forty-six patients underwent laparoscopic redo fundoplication during the study period for symptomatic hernia (n = 11), GERD (n = 18), or dysphagia (n = 17). GERSS improved from 41 at baseline to 9 at late follow-up (p < 0.001), and GERD-HRQL scores improved from 30 at baseline to 7 at late follow-up (p < 0.001). Median dysphagia scores decreased from 4.5 to 1 (p = 0.035). SF-36 scores demonstrated a significant improvement in general health (p = 0.016) and emotional well-being (p = 0.036) and a trend toward improved physical function (p = 0.068) in the post-operative period, but these improvements were not statistically significant at longer-term follow-up. Overall, 82% of patients reported satisfaction with their operation, and 96% reported that they would have the operation performed again given the benefit of hindsight.
  
  
  
  While associated with long operative times and significant complications, laparoscopic redo fundoplication produces a durable improvement in reflux symptoms and disease-specific quality of life. These procedures also improve global quality of life in the short term and are associated with high patient satisfaction.
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Sara E Martin
authors.initials: SEM
authors.lastname: Del Campo
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Mansfield
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Suzo
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hazey
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Kyle.Perry@osumc.edu.|Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, N729 Doan Hall, 410 W. 10th Ave, Columbus, OH, 43210, USA. Kyle.Perry@osumc.edu.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Perry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: GERD; Quality of life; Redo fundoplication; Symptom scores