Minimal access surgery compared with medical management for chronic gastro-oesophageal reflux disease: UK collaborative randomised trialBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2664 (Published 15 December 2008) Cite this as: BMJ 2008;337:a2664
All rapid responses
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
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
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.
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: No competing interests