2005 Abstracts: The Evolution, Duration and Personal Impact of Flatulence After Nissen Fundoplication
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The Evolution, Duration and Personal Impact of Flatulence After Nissen Fundoplication
Christy M. Dunst, Steven R. DeMeester, University of Southern California, Los Angeles, CA; Usha Desai, University of Southern California, Los California, CA; Jeffrey A. Hagen, Tom R. DeMeester, University of Southern California, Los Angeles, CA
BACKGROUND:Gastroesophageal reflux results in an increased frequency of swallowing. This likely serves to neutralize refluxed acid with alkaline saliva. Since air is propelled into the stomach with each swallow, bloating and repetitive belching often accompany gastroesophageal reflux disease. After successful antireflux surgery patients are typically unable to belch, and increased flatulence is an expected gastrointestinal side-effect. The aim of this study was to evaluate the evolution, duration and personal impact of flatulence after laparoscopic Nissen fundoplication.
METHODS: The National Registry for Antireflux Surgery and Barrett's Esophagus is a prospectively collected database of patients who had antireflux surgery by one of 42 participating community and university surgeons. Patients are followed at 6 month intervals with questionnaires either via the internet or a computerized telephony system using speech to text conversion software. Survey results are entered into a dedicated SQL server database in an automated fashion. The questionnaire includes a specific item assessing flatulence, the impact of which was rated using a 4 point scale (0=no increase, 1=mild, hardly worth mentioning, 2=moderate, not enough to impair ability to lead a normal life, 3=severe, daily problem that interferes with ability to lead a normal life). The 142 patients who underwent primary laparoscopic Nissen fundoplication and had more than one survey were included. RESULTS: Patients were followed for a median of 33.5 months after surgery. All patients reported increased flatulence after surgery. The impact of flatulence was reported as mild in 31%, moderate in 58% and severe in 11% on the first postoperative survey. Of the 15 patients who rated flatulence as severe, improvement was reported on the most recent survey in 47% (median interval between surveys 18.4 months). In the 127 patients with mild or moderate flatulence, 80% reported no change or improvement. Satisfaction with surgery was >95% regardless of the severity of reported flatulence. CONCLUSION: Increased flatulence is common after laparoscopic Nissen fundoplication. It is severe in only 11% and improves in nearly half. Despite this common side effect, over 95% of patients are satisfied with the results of surgery.
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