PATIENTS WITH LARYNGOPHARYNGEAL REFLUX MAY DERIVE LONG-TERM BENEFIT FROM ANTIREFLUX SURGERY
Alex Addo*, Philip E. George, Sara D. Parmiter, Andrew Broda, Hamid R. Zahiri, Adrian Park
Surgery, Anne Arundel Medical Center, Annapolis, MD
Background:
Antireflux surgery is efficacious in alleviating the typical symptoms of gastroesophageal reflux disease (GERD). However, the benefits of laparoscopic anti-reflux surgery (LARS) in patients with laryngopharyngeal reflux (LPR) symptoms have not been well established. Our study aimed to analyze differences in quality of life (QOL) outcomes after LARS between patients with LPR versus those without as part of their pathologic reflux.
Methods:
A retrospective review was conducted of a prospectively maintained database of patients with pathologic reflux, with or without LPR as defined by their composite Reflux Symptom Index (RSI) score, who underwent LARS between February 2012 and August 2019. Patients with a RSI score of > 13 were assigned to the LPR group and those with a score of ≤ 13 were assigned to the non-LPR group. Patient QOL outcomes were prospectively followed using four validated instruments: the Reflux Symptom Index (RSI), Laryngopharyngeal Reflux QOL (LPR-QOL), Swallowing QOL (SWAL), and Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQOL) surveys. Significance was defined by a p value less than 0.05.
Results:
549 patients (28% male, 72% female) were included in the final analysis. The LPR and non-LPR group were similar in mean BMI (29 vs. 28), distribution of ASA score and comorbid disease, and mean Johnson-Demeester score (41 vs. 46). The two groups were parallel in wound and non-wound complications. There was lower incidence of LPR in patients with Paraesophageal hernias (64% vs. 78%). At a mean follow-up of 20 months, the LPR group reported significant improvements in hoarseness (59%), dysphagia (44%), chronic cough (73%) and heartburn (71%). The non-LPR group reported significantly lower QOL scores than the LPR group after LARS, but the LPR group had the greatest improvement from baseline (RSI: 59% vs. 19; GERD: 78% vs. 77%; LPR: 74% vs. 64%; SWAL: -25% vs. -4%).
Conclusion:
Our results demonstrate that antireflux surgery is equally efficacious in the treatment of GERD with LPR with sustained long-term QOL benefits. Comprehensive, multi-disciplinary workup to ensure laryngo-pharyngeal manifestations are secondary to reflux is key to optimize outcomes.
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