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RESEARCH: Adrian M Grant, Samantha M Wileman, Craig R Ramsay, N Ashley Mowat, Zygmunt H Krukowski, Robert C Heading, Mark R Thursz, Marion K Campbell and the REFLUX Trial Group Minimal access surgery compared with medical management for chronic gastro-oesophageal reflux disease: UK collaborative randomised trial BMJ 2008; 337: a2664 [Abstract] [Full text]

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Evaluation of long term outcomes after laparoscopic Nissen fundoplication

Bettina Lieske, Andrew Gordon   (4 February 2009)

Evaluation of long term outcomes after laparoscopic Nissen fundoplication 4 February 2009
Bettina Lieske, SpR General Surgery Heatherwood & Wexham Park Hospitals NHS Foundation Trust, Slough, Berkshire, SL2 4HL, Andrew Gordon Send response to journal: Re: Evaluation of long term outcomes after laparoscopic Nissen fundoplication	We congratulate Grant et al 1 on their study as an excellent model of how to conduct valuable research within a “real life” context. One of the current main limitations of the study however is the lack of long-term follow up data. We have recently undertaken an evaluation of long term outcomes after laparoscopic Nissen fundoplication within the setting of our DGH. We carried out an interview by telephone, using a standardised questionnaire (including Visick Score) and contacted 126 patients (93 male, median age 47 (range 20-76)). Follow-up was 81-142 months (median 100). Pre-operative symptoms of reflux, heartburn, indigestion, pain, sickness & vomiting were permanently resolved by the surgery in 109 patients (87%). Current symptoms comprise heartburn, regurgitation and dysphagia of varying degrees. Thirty-two patients are unable to belch and 95 noticed increased flatulence following the surgery, a finding enhancing the statement by Grant et al that “wind from the lower bowel” was more frequent after surgery; and although we recorded Visick scores I and II in 75% of patients, more patients stated bloating and flatulence as the main reason for scores III – V than recurrent or residual symptoms. At interview, 23 patients (18%) were taking anti-reflux mediation. Following the surgery, 19 patients (15%) had stopped their PPIs and re- started them later, but only 3% re-started within the first 12 months after surgery. This indicates that the 14% quoted by Grant et al might well increase with longer follow up. However, we asked patients whether they would have the surgery again given the choice and 90% answered “yes”, whilst 91% would recommend it to a friend or relative, thus showing high patient satisfaction in the long term. Long term follow up is time-consuming and often difficult when done in a real life setting due to patient attrition rates and limited resources. We hope that our study supports Grant et al’s findings that symptom relief and improved quality of life after laparoscopic fundoplication is a sustained finding in the long term. References: 1. Grant AM, Wileman SM, Ramsay CR et al. Minimal access surgery compared with medical management for chronic gastro-oesophageal reflux disease: UK collaborative randomised trial. BMJ 2008; 337: a2664 Competing interests: None declared