Laparoscopic Nissen Fundoplication Effectively Relieves Symptoms in Patients with Laryngopharyngeal Reflux
Robert a. Catania*1, Stephen M. Kavic1, J. Scott Roth1, Tommy H. Lee1, Tanya Meyer2, George T. Fantry3, Adrian E. Park1
1Department of Surgery, University of Maryland Medical Center, Baltimore, MD; 2Department of Otolaryngology, University of Maryland Medical Center, Baltimore, MD; 3Department of Gastroenterology, University of Maryland Medical Center, Baltimore, MD
Background: Laparoscopic Nissen fundoplication (LNF) has been established as the “gold standard” therapy for gastroesophageal reflux, however its utility in the treatment of “atypical” reflux symptoms remains controversial. Symptoms including pharyngitis, globus, dysphagia, cough, and hoarseness, make up the presenting complaints of laryngopharyngeal reflux (LPR). We hypothesized that patients with symptoms of LPR and documented reflux would benefit from LNF.
Methods: Since January 2004, 60 patients with LPR underwent LNF at a single institution. Preoperative evaluation including upper endoscopy, laryngoscopy, and dual channel 24-hour ambulatory pH probe monitoring was used to confirm the diagnosis prior to surgery. Preoperatively, all patients were administered two validated assessment instruments, the Reflux Symptomatic Index (RSI) and the laryngopharyngeal reflux quality of life instrument (LPR-HRQL). Symptomatic monitoring was then prospectively quantified with these instruments at 1, 6, 12, and 24 months postoperatively. Mean follow-up was 14 months, with 20 patients being followed for 2 or more years. The Students t-test was used for statistical evaluation with a p-value less than 0.05 considered significant.
Results: There was a dramatic and statistically significant decrease from preoperative scores in all indices measured as early as one month after surgery. The results are summarized below.
Conclusions: LNF is an efficacious therapy for symptomatic LPR in a carefully selected patient population. Symptomatic improvement is seen as early as 1 month after surgery and that improvement persists after 2 years of follow-up.
| Pre | 1 Month | 6 Months | 12 Months | 24 Months | |
| RSI | 30.8±2.0 | 10.6±2.7* | 12.7±3.9* | 11.9±3.5* | 11.0±4.3* |
| Cough | 15.7±3.0 | 3.2±1.9* | 5.5±3.1* | 3.7±2.2* | 3.7±2.7* |
| Throat | 15.1±2.6 | 5.2±2.5* | 5.2±2.7* | 4.4±2.2* | 3.0±1.7* |
| Swallow | 14.4±2.4 | 3.7±2.0* | 3.0±1.7* | 3.0±2.0* | 2.6±1.9* |
| Voice | 27.2±5.4 | 11.8±6.5* | 9.0±6.1* | 10.6±5.6* | 8.2±5.1* |
| Overall | 53.4±7.3 | 14.0±6.9* | 14.4±8.3* | 13.2±7.3* | 10.5±5.3* |
Results expressed as Mean ± 95% Confidence Interval, * P<0.05 compared to preoperative value
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