Impact of Laparoscopic Total versus Partial Fundoplication on Patients Quality of Life
Abstracts
|
Background: While functional and symptomatic outcome following laparoscopic antireflux surgery (LARS) has been well documented, there is a increasing interest in evaluating quality of life data in patients with gastroesophageal reflux disease (GERD). Aim of this prospective study was to compare the impact of either Nissen or Toupet fundoplication on patients quality of life for a follow-up period of 3 years after surgery. Patients and methods: Between 1993 and 1998, a group of 200 consecutive GERD patients underwent a laparoscopic antireflux procedure in our surgical unit. Patients with preoperative normal esophageal motility underwent a laparoscopic Nissen fundoplication (n=100), patients with impaired esophageal motility (<30mmHg in the lower esophageal segments in response to wet swallows) or severely disordered peristalsis (>40% simultaneous contractions in wet swallows) underwent a laparoscopic Toupet hemifundoplication (n=100). Quality of life was evaluated using the Gastrointestinal Quality of Life Index (GIQLI). The GIQLI was evaluated prior to surgery, 3 months, 1 year and three years after surgery, with 24-pH-monitoring and esophageal manometry being performed. Results: In the Nissen group, the mean general score of GIQLI improved significantly from preoperatively 89.8 (+8.6) points to 118.2 (+7.9) points at 6 weeks after surgery. Three months after surgery, GIQLI showed further improvement up to 123.2 (+8.7) points and remained stable up to 1 year (123.4 +8.6 points) and 3 years after surgery (123.0 +9.0 points). In the Toupet group, the mean general score of GIQLI was 90.8 (+points. Six weeks after surgery, the mean general index improved significantly (p<0.05) to a score of 118.9 +8.7 points. Three months and one year year after surgery, the mean GIQLI showed further improvement with comparable scores to healthy individuals: 120.6 +7.9 points respectively 121.4 +8.1 points. The mean GIQLI remained almost stable 3 years (120.9 +7.7 points) after laparoscopic Toupet fundoplication. Conclusion: Patients with gastroesophageal reflux disease have a poor quality of life when compared with healthy individuals. Laparoscopic antireflux surgery improves quality of life significantly for a follow-up period of 3 years after surgery. There is no significant difference in quality of life outcome after either Nissen or Toupet fundoplication for this period. |
