1998 Abstract: MULTIVARIATE ANALYSIS OF THE FACTORS PREDICTING OUTCOME AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION. G.M.R. Campos, J.H. Peters, T.R. DeMeester, S. Öberg, M. DeVos-Shoop, J. Theisen, M. Hashemi, P. Crookes, J. Hagen, C.G. Bremner. Department of Surgery, University of Southern California, Los Angeles, CA. 35
Abstracts 1998 Digestive Disease Week
#2327
MULTIVARIATE ANALYSIS OF THE FACTORS PREDICTING OUTCOME AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION. G.M.R. Campos, J.H. Peters, T.R. DeMeester, S. Öberg, M. DeVos-Shoop, J. Theisen, M. Hashemi, P. Crookes, J. Hagen, C.G. Bremner. Department of Surgery, University of Southern California, Los Angeles, CA.
Patient selection is critical in achieving a successful outcome of anti-reflux surgery. The aim of this study was to determine the variables that can predict outcome after laparoscopic Nissen fundoplication. A stepwise logistic regression analysis was performed on data from 158 consecutive patients undergoing laparoscopic Nissen fundoplication between 1991 and 1996. Variables included age (<50 or _50 years); sex; typical or atypical primary symptoms; erosive esophagitis; composite acid score and percent time below pH 4 on 24h pH monitoring; lower esophageal sphincter status; hiatal hernia (_2cm), inflammation or intestinal metaplasia of the cardiac epithelium on histology and Barrett's esophagus of any length. Clinical outcome was obtained from all patients and assessed via a questionnaire at a median follow-up of 12 months (range:5-58) after surgery. The outcome was considered excellent in asymptomatic patients, good when the primary symptom was relieved but minor gastrointestinal symptoms remained, fair when the primary symptom was improved but persisted and/or there was necessity for additional therapy and poor when symptoms were equal or worse than before surgery. One hundred thirty three of the 158 patients had an excellent or good outcome (84%) and 25 a fair or poor outcome. Only two factors were significantly predictive of a successful outcome (see table): a positive composite acid score on 24h pH monitoring (Odds ratio=3.19, 95% confidence limits=1.23-8.25) and the presence of a typical primary symptom (Odds ratio=4.71, 95% confidence limits=1.84-12.06).
Variable
Symptom
Score
Outcome
Typical
Atypical
_ 14.8
< 14.8
Excellent/Good
90%
64%
89%
69%
Fair/Poor
10%
36%
11%
31%
Wald's p-value
0.0007
0.0001
We conclude that the presence of typical symptoms or a positive composite acid score on 24h pH monitoring are highly predictive of a successful outcome following laparoscopic Nissen fundoplication. Twenty four-hour pH monitoring should be included in the pre-operative evaluation of all candidates for laparoscopic fundoplication as it is the only objective test capable of predicting outcome.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
