Reflux Laryngitis: A Feasible Indication for Laparoscopic Antireflux Surgery?

Abstract

Laparoscopic fundoplication is a routine surgical approach in the treatment of moderate or severe gastro-esophageal reflux disease. However, there are still contradictions regarding supraesophageal symptoms as an indication for surgery. The aim of this study was to determine the subjective symptomatic outcome and objective laryngeal findings after antireflux surgery in patients with pH monitoring proven reflux laryngitis. Between 1998 and 2002, 40 patients with reflux laryngitis underwent laparoscopic Nissen fundoplication. Patients were referred to surgery and followed-up by a specialist in otorhinolaryngology. Subjective symptoms were collected by a structured questionnaire at a median follow-up of 42 months. The objective laryngeal findings improved from the preoperative situation; at 12 months after surgery, the otorhinolaryngeal status was improved in 92.3% (n=24) of the patients. However, only 38.5% (n=10) of these patients evaluated an improvement in their voice quality. Of all, 62.5% (n=25) of the patients reported no or only mild cough or voice hoarseness symptoms postoperatively, 22.5% (n=9) had moderate symptoms, and 15.0% (n=6) suffered from difficult supraesophageal symptoms. Ninety-five percent of the patients regarded the result of their surgery excellent, good, or satisfactory. Of all, 82.5% (n=33) of the patients would still choose surgery, 7.5% (n=3) would abstain from surgery, and 10% (n=4) of the patients were hesitant about their choice. For patients suffering from supraesophageal symptoms of gastro-esophageal reflux disease with objective evidence of pharyngeal acid exposure, laparoscopic Nissen fundoplication provides a good and alternative adding to current treatment.

Long-Term Outcomes after Laparoscopic Nissen Fundoplication for Reflux Laryngitis

“…In our selective group of patients the pH-monitored objective evidence of pharyngeal reflux was considered an inclusion criterion for surgical treatment. The reported short-term results of antireflux surgery in the management of LPR have been promising comparing similarly with those patients treated for typical GERD symptoms [8,9,10,16,17,18]. However, fairly little is known about the long-term effectiveness and outcome of LNF in the treatment of extraesophageal complications of GERD.…”

“…However, based on the multifactor nature of both laryngeal symptoms and GERD itself, inconsistencies between the objective laryngeal findings, patients’ subjective evaluation of their voice quality and patient satisfaction have been shown to exist [8,13,19,20]. After a mean follow-up of 7.6 years, 69.4% (n = 25) of our patients in this study regarded their voice quality improved, which is in accordance with 69.4% (n = 25) of the patients again choosing surgery as the optimal treatment for their reflux laryngitis.…”

“…More typical GERD symptoms were also present in 57.5% of the patients. We have also previously reported mid-term surgical results of these patients also describing the operative techniques, preoperative pH monitoring results and preoperative endoscopic findings in detail [8]. One of the patients underwent a reoperation (at 28 months after surgery, conversion to laparotomy due to adhesions) for recurrent reflux due to a disrupted plication; the late outcome of this patient is included in the analysis.…”

Heterotopic Gastric Mucosal Patch in Patients With Reflux Laryngitis: An Entity of Clinical Interest?

“…The detailed pH-monitoring results have been reported earlier. 7 All of these patients were referred to surgery by a specialist in otolaryngology and they underwent a comprehensive preoperative otolaryngology examination. The clinical details of the patients enrolled in the study, the methods, and the operative techniques have been described earlier in detail.…”

“…6 We recently reported our experience of laparoscopic antireflux surgery in the treatment of supraesophageal complications of GERD in patients (n = 40) with pHproven LPR. 7 In these patients HGMPs were not specifically examined at the time of preoperative endoscopy and we recognize the possibility of missing the HGMP diagnosis as a possible etiological factor for LPR. The aim of this study was to investigate the prevalence of HGMP in the cervical esophagus in this specific LPR patient group operated on for GERD-induced reflux laryngitis and evaluate the clinical significance of this lesion in these patients with objective LPR.…”