“Floppy” Nissen vs. Toupet Laparoscopic Fundoplication: Quality of Life Assessment in a 5-Year Follow-Up (Part 2)

 

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Background and Study Aims: Quality of life as an outcome variable has become an important measure in clinical research. This study is the second part of a prospective assessment of the quality of life outcome, in a 5-year follow-up of patients who underwent laparoscopic Nissen fundoplication or Toupet fundoplication. Data from a 1-year follow-up have been previously published (part I).
Patients and Methods: Using the Gastrointestinal Quality of Life Index (GIQLI), the quality of life data of 169 consecutive patients who had undergone a laparoscopic Nissen fundoplication (LNF; n = 104) or a laparoscopic Toupet fundoplication (LTF; n = 65), were evaluated 3 years and 5 years postoperatively. Six patients out of the initial study group (n = 175), including three from each group, were excluded from the main analysis because they had undergone laparoscopic re-fundoplication during the 1-year follow-up. Data from patients with repeat surgery have been analysed separately. In addition to administering the GIQLI, we evaluated patient satisfaction with surgery, possible surgical side effects or recurrent disease-related symptoms, the use of antireflux medication, and also surgical interventions in relation to initial antireflux surgery. In those patients, who were willing (n = 111) we also performed esophageal manometry and 24-hour pH monitoring 5 years postoperatively.
Results: At 3 years and 5 years postoperatively, the analysis of quality of life data showed that the GIQLI score remained stable in comparison with the 1-year follow-up data, with mean scores of 121 ± 8.7 points in the LNF-group and 119.8 ± 9 points in the LTF-group, at 5 years after surgery. Laparoscopic re-fundoplication was necessary in four patients due to a “slipping” Nissen (LNF group n = 1) or recurrent symptoms (LTF group, n = 3). In two patients in the LTF group herniation of a trocar incision was found. No patient suffered from severe surgical side effects. Patient satisfaction with surgery was rated as “excellent” or “good” in 97.9 % of patients. There were no significant differences between the groups concerning these data. The results of esophageal manometry and 24-hour pH monitoring also remained stable and showed normal values in all but two patients (in the LTF group), who suffered from mild and infrequent symptoms of recurrent heartburn without endoscopic signs of esophagitis. The outcome in patients who underwent laparoscopic re-fundoplication is comparable to the outcomes for those with a successful primary intervention.
Conclusions: Both Nissen and Toupet laparoscopic fundoplication can significantly improve patients' quality of life during the 5 years following surgical intervention. Quality of life scores for both surgical groups were almost equal and postoperative outcomes were comparable to values in healthy controls. Patient satisfaction with surgical treatment was very high, even though repeat laparoscopic surgery was necessary in some cases. Patients who had a repeat procedure experienced nearly identical outcomes.

References

• 1 Dent J, Brun J, Fendrick A M. et al . An evidence-based appraisal of reflux disease management - the Genval Workshop Report.  Gut. 1999;  44 S1-S16
  CrossrefPubMedGoogle Scholar
• 2 Fuchs K H, Feussner H, Bonavina L. et al . Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting.  Endoscopy. 1997;  29 289-308
  PubMedGoogle Scholar
• 3 Archer S B, Sims M M, Giklich R. et al . Outcomes assessment and minimally invasive surgery. Historical perspective and future directions.  Surg Endosc. 2000;  14 883-890
  CrossrefPubMedGoogle Scholar
• 4 Wiklund I, Bardhan K D, Müller-Lissner S. et al . Quality of life during acute and intermittent treatment of gastro-oesophageal reflux disease with omeprazole compared with ranitidine. Results from a multicentre clinical trial.  Ital J Gastroenterol Hepatol. 1998;  30 19-27
  PubMedGoogle Scholar
• 5 Revicki D A, Crawley J A, Zodet M W. et al . Complete resolution of heartburn symptoms and health-related quality of life in patients with gastro-oesophageal reflux disease.  Aliment Pharmacol Ther. 1999;  13 1621-1630
  CrossrefPubMedGoogle Scholar
• 6 Trus T L, Laycock W S, Waring J P. et al . Improvement in quality of life after laparoscopic antireflux surgery.  Ann Surg. 1999;  229 331-335
  CrossrefPubMedGoogle Scholar
• 7 Fernando H C, Schauer P K, Rosenblatt M. et al . Quality of life after antireflux surgery compared with nonoperative management for severe gastroesophageal reflux disease.  J Am Coll Surg. 2002;  194 23-27
  CrossrefPubMedGoogle Scholar
• 8 Kamolz T, Granderath F A, Bammer T. et al . Mid- and long-term quality of life assessment after laparoscopic fundoplication and re-fundoplication: a single unit review of more than 500 antireflux procedures.  Dig Liver Dis. 2002;  34 470-476
  CrossrefPubMedGoogle Scholar
• 9 Lundell L, Miettinen P, Myrvold H E. et al . Continued (5-year) follow-up of a randomised clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease.  J Am Coll Surg. 2001;  192 172-179
  CrossrefPubMedGoogle Scholar
• 10 Spechler S J, Lee E, Ahnen D. et al . Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease. Follow-up of a randomised controlled trial.  JAMA. 2001;  285 2331-2338
  CrossrefPubMedGoogle Scholar
• 11 Kamolz T, Bammer T, Wykypiel, Jr H. et al . Quality of life and surgical outcome after laparoscopic Nissen and Toupet fundoplication: one-year follow-up.  Endoscopy. 2000;  32 363-368
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Bammer T, Kamolz T, Pointner R. Minimal invasive Antirefluxchirurgie.  Acta Chir Austriaca. 2000;  32 21-25
  PubMedGoogle Scholar
• 13 Kamolz T, Granderath F A, Bammer T. et al . Psychological intervention influences the outcome of laparoscopic antireflux surgery in patients with stress-related symptoms of gastroesophageal reflux disease.  Scand J Gastroenterol. 2001;  36 800-805
  PubMedGoogle Scholar
• 14 Eypasch E, Wood-Dauphinée S, Williams J I. et al . Der Gastrointestinale Lebensqualitätsindex (GLQI).  Chirurg. 1993;  64 264-274
  PubMedGoogle Scholar
• 15 Koop H. Gastroesophageal reflux disease and Barrett's esophagus.  Endoscopy. 2002;  34 97-103
  Article in Thieme ConnectPubMedGoogle Scholar
• 16 Revicki D A, Wood M, Maton P N. et al . The impact of gastroesophageal reflux disease on health-related quality of life.  Am J Med. 1998;  104 252-258
  CrossrefPubMedGoogle Scholar
• 17 Velanovich V. Quality of life and severity of symptoms in gastro-oesophageal reflux disease: a clinical review.  Eur J Surg. 2000;  166 516-525
  CrossrefPubMedGoogle Scholar
• 18 Horvath K D, Jobe B A, Herron D M. et al . Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease.  J Gastrointest Surg. 1999;  3 583-591
  CrossrefPubMedGoogle Scholar
• 19 Klapow J C, Wilcox C M, Mallinger A P. et al . Characterization of long-term outcomes after Toupet fundoplication: symptoms, medication use, and health status.  J Clin Gastroenterol. 2002;  34 509-515
  CrossrefPubMedGoogle Scholar
• 20 Gadenstätter M, Klingler A, Prommegger R. et al . Laparoscopic partial posterior fundoplication provides excellent intermediate results in GERD patients with impaired esophageal peristalsis.  Surgery. 1999;  126 548-552
  CrossrefPubMedGoogle Scholar
• 21 Granderath F A, Kamolz T, Schweiger U M. et al . Quality of life and symptomatic outcome three to five years after laparoscopic Toupet fundoplication in gastroesophageal reflux disease patients with impaired esophageal motility.  Am J Surg. 2002;  183 110-116
  CrossrefPubMedGoogle Scholar
• 22 Slim K, Bousquet J, Kwiatkowski F. et al . Quality of life before and after laparoscopic fundoplication.  Am J Surg. 2000;  180 41-45
  CrossrefPubMedGoogle Scholar
• 23 Möbius C, Stein H J, Feith M. et al . Quality of life before and after laparoscopic Nissen fundoplication.  Surg Endosc. 2001;  15 353-356
  CrossrefPubMedGoogle Scholar
• 24 Barrat C, Capelluto E, Catheline J-M. et al . Quality of life 2 years after Iaparoscopic total fundoplication.  Surg Laparosc Endosc Percutan Tech. 2001;  11 347-350
  CrossrefPubMedGoogle Scholar
• 25 Kamolz T, Bammer T, Granderath F A. et al . Comorbidity of aerophagia in GERD patients: outcome of laparoscopic antireflux surgery.  Scand J Gastroenterol. 2002;  37 138-143
  CrossrefPubMedGoogle Scholar
• 26 Velanovich V, Karmy-Jones R. Psychiatric disorders affect outcomes of antireflux operations for gastroesophageal reflux disease.  Surg Endosc. 2001;  15 171-175
  CrossrefPubMedGoogle Scholar
• 27 Kamolz T, Bammer T, Granderath F A. et al . Laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders.  Dig Liv Dis. 2001;  33 659-664
  PubMedGoogle Scholar
• 28 Kamolz T, Bammer T, Pasiut M. et al . Gesundheitsbezogene und krankheitsspezifische Lebensqualität als Beurteilungsmaß der laparoskopischen Refundoplication.  Chirurg. 2000;  71 707-711
  CrossrefPubMedGoogle Scholar
• 29 Granderath F A, Kamolz T, Schweiger U M. et al . Is laparoscopic re-fundoplication feasible in patients with failed primary open antireflux surgery?.  Surg Endosc. 2002;  16 381-385
  CrossrefPubMedGoogle Scholar

T. Kamolz, Ph.D.

Division of Clinical Psychology · Zell am See Public Hospital

5700 Zell am See · Austria ·

Email: kamolz@utanet.at