Factors predicting outcomes of laparoscopic Nissen fundoplication for gastroesophageal reflux disease: experience at a single institution in Korea

Abstract

PurposeLaparoscopic fundoplication is considered the standard surgical treatment for gastroesophageal reflux disease (GERD) in Western countries. However, some patients experience poor surgical outcomes with this procedure. The study aimed to identify the predictive factors of the surgical outcomes of laparoscopic Nissen fundoplication for the treatment of Korean GERD patients.MethodsSixty-one patients with GERD were treated using laparoscopic Nissen fundoplication between November 2012 and February 2015. Symptom control rates were compared according to clinical and surgical factors to identify predictive factors of successful surgical outcomes.ResultsThirty-five men and 26 women were enrolled. Preoperatively, typical symptoms were present in 60 patients (98%), while atypical symptoms were present in 40 patients (66%). Postoperatively, typical symptoms were controlled in 51 of 60 patients (85.0%), while atypical symptoms were controlled in 33 of 40 patients (82.5%). Overall, at 6 months postsurgery, 54 (88.5%) reported some resolution of GERD symptoms, with 48 (78.7%) achieving complete control. Patients who exhibited a good response to proton pump inhibitor therapy had a significantly greater rate of complete symptom control (P = 0.035).ConclusionLaparoscopic fundoplication is effective for controlling GERD symptoms. Response to preoperative proton pump inhibitor was a predictor of successful outcome.

Multicenter Prospective Study of Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease in Korea

“…Although the number of operations is much less than the number of operations in the Western countries, there have been several reports on the outcomes of anti-reflux surgery in Korea. [2][3][4][5] The Korean anti-reflux surgery study group (KARS) conducted a nationwide survey among surgeons in Korea and reported the outcome of anti-reflux surgery in 87 patients. The results reported that laparoscopic fundoplication is an efficient treatment method for controlling GERD symptoms.…”

“…All previous reports in Korea were of a retrospective case series nature. [2][3][4][5] There has been no prospective study to date. The present study was the first multicenter prospective study evaluating the outcome of laparoscopic anti-reflux surgery in Korea.…”

“…Improvement or resolution of GERD symptoms by anti-reflux surgery in this study was almost the same as that reported in previous studies. 2,3,11 Symptomatic improvement after anti-reflux surgery was different for different types of GERD symptoms. Almost all patients had typical symptoms and at the same time, most had atypical symptoms.…”

“…This was different from previous studies in which surgeons' early experiences were included. [2][3][4][5] The goal of anti-reflux surgery is to fix primary GERD symptoms and, at the same time, avoid additional adverse side effects. Therefore, for comprehensively assessing the outcome of anti-reflux surgery, in addition to the improvement of GERD symptoms, it is useful to evaluate patient satisfaction or general QOL that can assess post-fundoplication side effects.…”

“…Despite this, the number of anti-reflux surgeries in Korea has recently increased, and there have been several studies reporting the outcome of anti-reflux surgery. [2][3][4][5] However, there are no prospective studies comparing the efficacy of anti-reflux surgery and its effect on quality of life (QOL) with medical treatment.…”