Outcomes Following Laparoscopic Antireflux Surgery (LARS) in Patients with and without Endoscopic Esophagitis
Abstracts
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[Objective]: A wide spectrum of endoscopic findings, ranging from normal mucosa to Barrett's esophagus, exists in patients with gastroesophageal reflux disease (GERD). Many patients with GERD have normal endoscopic studies yet benefit from high dose anti-secretory therapy. This study compared clinical outcomes following LARS in GERD patients with and without preoperative esophagitis. [Method]: From 1992 to present, 414 patients who underwent LARS were prospectively analyzed and clinical follow-up of > 5 months was obtained. Of these, 97 (23%) had no endoscopic evidence of esophagitis at most recent endoscopy (Group1), while 317 (77%) had grade I-V esophagitis (Group 2) with Barrett's esophagitis evident in 77 (24%) of these patients. Mean (± SD) postoperative follow-up for Group 1 and Group 2 was 21 (± 15) and 35 (± 24) months respectively. The presence or absence of GERD-like symptoms and the use of acid-reduction medication were assessed. [Results]: Preoperative DeMeester scores on 24 hour pH testing in Groups 1 and 2 were 44 ± 30 and 61 ± 62 (NS), respectively and mean lower esophageal sphincter (LES) pressure was 10 ± 7 in Group 1 and 8 ± 6 in Group 2. Medication use and GERD symptoms were reduced in both groups following LARS. With the exception of postoperative dysphagia, there were no differences between Groups 1 and 2. [Conclusions]: LARS is an effective treatment option for patients irrespective of endoscopic evidence of esophagitis. The presence or absence of preoperative esophagitis has minimal effect on favorable symptomatic outcomes following LARS. Patients without endoscopic disease, potentially subject to long-term medical management, can rely upon durable surgical treatment. |
