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Background: Laparoscopic antireflux surgery with or without large hiatal hernia has been shown to have good short term outcomes. However, limited data are available on long term outcomes of greater than 5 years. The aim of this study is to review functional and symptomatic outcomes of anitreflux surgery in a large tertiary referral medical center.

Methods: Three hundred and fifteen patients who underwent laparoscopic anti-reflux surgery at the University of Nebraska Medical Center between 2002 and 2012 were included in this study. Patient data including pre and post-operative studies and symptom questionnaires were prospectively collected and the database was used to analyze postoperative outcomes. Statistical analysis including multivariate regression models were used to compare patient factors and their effect on outcomes.

Results: A total of 302 Nissen fundoplications, 24 redo fundopliations, 11 Toupet and 2 Dor procedures were performed. Mean BMI was 31%. The median follow up was 68 (6-130) months. There were 3 reoperations (0.9%) for recurrent symptoms. Mesh was used in 210 cases where hiatal hernia was larger than 2cm. Median preoperative DeMeester score was 60.5 which decreased to 6 (p<0.05). Heartburn (N=264) improved in 245 (92%), regurgitation (N=264) improved in 256 (97%) and dysphagia (N=253) improved in 227 (89%). Atypical presentation such as pulmonary and throat symptoms only, improved in 82% of patients. Radiographic studies were available in 60% of the patients with mean follow up of 1.5 years with evidence of overall recurrence of 7 % (21% in hiatal hernia > 5cm). Of those with recurrence over 91% were asymptomatic at follow up. Male gender, advanced age, size of hiatal hernia, and preoperative BMI are independent predictors of worse outcomes.

Conclusions: Antireflux surgery is effective in controlling symptoms of reflux and correction of hiatal hernia in long term follow up of greater than 5 years. The durability of this procedure can be affected by large hiatal hernia and high BMI and male sex. Overall patients were very satisfied with the operation even after 10 years of follow up.