2005 Abstracts: Personal Impact of Abdominal Cramping and Bloating After Laparoscopic Nissen Fundoplication
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Personal Impact of Abdominal Cramping and Bloating After Laparoscopic Nissen Fundoplication
Christy M. Dunst, Steve R. DeMeester, Usha Desai, Jeffrey A. Hagen, Tom R. DeMeester, University of Southern California, Los Angeles, CA
BACKGROUND:Compensatory swallowing is common in gastroesophageal reflux disease and may be accompanied by air swallowing and frequent belching. However, the ability to belch is often impaired after antireflux surgery and may lead to the sensation of abdominal bloating. The aim of this study is to evaluate the evolution, duration and personal impact of abdominal cramping and bloating 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 specific items assessing abdominal cramping and bloating, 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. Seventy-three patients (51%) reported increased abdominal cramping and bloating on their first postoperative survey. The impact was mild in 22 (15%), moderate in 42 (30%) and severe in 9 (6%). Symptoms subsequently improved in 28 (38%) and resolved in 10 (14%). The median time to resolution was 27.1 months. Satisfaction with surgery was >95% in all rating groups. CONCLUSION: Following laparoscopic Nissen fundoplication, 51% of patients experience an increase in abdominal cramping or bloating. It improves or resolves in more than half, and is rarely significant enough to impact daily life. Further, more than 95% are satisfied with surgery regardless of the severity of these symptoms.
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