Medium-term outcome of fundoplication after lung transplantation

Abstract

Gastroesophageal reflux disease (GERD) in lung transplant recipients has gained increasing attention as a factor in allograft failure. There are few data on the impact of fundoplication on survival or lung function, and less on its effect on symptoms or quality of life. Patients undergoing fundoplication following lung transplantation from 1999 to 2005 were included in the study. Patient satisfaction, changes in GERD symptoms, and the presence of known side effects were assessed. The effect on lung function, body mass index, and rate of progression to the bronchiolitis obliterans syndrome (BOS) were recorded. Twenty-one patients (13 males), in whom reflux was confirmed on objective criteria, were included, with a mean age of 43 years (range 20-68). Time between transplantation and fundoplication was 768 days (range 145-1524). The indication for fundoplication was suspected microaspiration in 13 and symptoms of GERD in 8. There was one perioperative death, at day 17. There were three other late deaths. Fundoplication did not appear to affect progression to BOS stage 1, although it may have slowed progression to stage 2 and 3. Forced expiratory volume-1% predicted was 72.9 (20.9), 6 months prior to fundoplication and 70.4 (26.8), six months post-fundoplication, P= 0.33. Body mass index decreased significantly in the 6 months following fundoplication (23 kg/m(2) vs. 21 kg/m(2), P= 0.05). Patients were satisfied with the outcome of the fundoplication (mean satisfaction score 8.8 out of 10). Prevalence of GERD symptoms decreased significantly following surgery (11 of 14 vs. 4 of 17, P= 0.002). Fundoplication does not reverse any decline in lung function when performed at a late stage post-lung transplantation in patients with objectively confirmed GERD. It may, however, slow progression to the more advanced stages of BOS. Reflux symptoms are well controlled and patients are highly satisfied. Whether performing fundoplication early post-lung transplant in selected patients can prevent BOS and improve long-term outcomes requires formal evaluation.

How useful is antireflux surgery in lung transplant patients with gastroesophageal reflux?

“…Resolution of reflux symptoms as well as significant improvement in satisfaction with their condition was observed after antireflux procedures. These data support other authors findings [19,20]: Burton in 2009 found that after laparoscopic Toupet fundoplication in lung transplant patients 88% of the patients rated the surgery as excellent, Robertson et al noticed significant improvement in reflux symptoms index and gastrointestinal quality of life scores. However most of the studies evaluate short-term fundoplication effect.…”

Anti-reflux surgery in lung transplant recipients: outcomes and effects on quality of life

“…Our study has comparable intra-operative data and no patients in our series have needed conversion to an open operation. No intra-operative or perioperative deaths have been reported by the Duke University group [5,23,24], although, recently, one post-fundoplication death has been reported [25]. We have experienced no mortality to date and no major complications were encountered.…”

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

“…Nissen fundoplication and Toupet fundoplication) can be performed safely on lung transplant candidates with advanced lung disease or lung transplant recipients with documented abnormal GOR [123,124,[127][128][129][132][133][134][135][136][137][138], thereby preventing reflux, aspiration of gastric secretions and related sequelae.…”