FACT VS. FICTION: WHY DO PATIENTS AVOID ANTI-REFLUX SURGERY? ADDRESSING THEIR CONCERNS HEAD-ON
Mian H. Hanif*, Justin Turcotte, Paul Kim, Adrian Park
Anne Arundel Medical Center, Annapolis, MD
Introduction: Laparoscopic anti-reflux surgery (LARS) has been demonstrated to be a highly effective procedure for the treatment of gastroesophageal reflux disease (GERD). Despite this documented success, many patients still have an aversion to surgery and concerns regarding side effects following surgery. While some concerns are legitimate, others are based upon inaccurate information found on publicly available websites and social media platforms. The purpose of this study is to identify the most commonly referenced concerns about LARS and to address the misconceptions following LARS.
Methods: A thorough search was conducted on various social media platform and patient-centered forums to identify common adverse perceptions of LARS. Frequently reported concerns included: the benefits of anti-reflux surgery are not long-lasting, patients will have a persistent need for anti-reflux medications postoperatively, patients will experience postoperative dysphagia or odynophagia, and fundoplication is not reversible. A prospectively maintained database of clinical and patient reported outcomes following LARS was then reviewed to quantify rates of these symptoms pre- and postoperatively. Chi-square tests were performed to assess differences in outcomes between the preoperative and postoperative (30 days to 5 years) periods. Statistical significance was assessed at p<0.05.
Results: Compared to the preoperatively, patients were less likely to require anti-reflux medication and report symptoms of dysphagia, odynophagia, heartburn, hoarseness, coughing up undigested food or respiratory distress at 4-weeks postoperatively (all p<0.0001). These improvements in symptoms remained significant through the 5-year postoperative time point (all p<0.001). Only 87/1369 (6.3%) patients underwent revision of Nissen fundoplication and 3/1369 (0.02%) underwent conversion from Nissen to Toupet fundoplication. After revision, the 30-day readmission rate was 6.8%, complication rate was 15.0% (all non-surgical), and reoperation rate was 3.4%.
Conclusions: Patients undergoing LARS experienced significant reductions in a variety of symptoms and potential side effects such as dysphagia that are commonly misperceived to persist after surgery. These improvements remained over a five-year period. A small subset of patients underwent any revisional surgery (6.3%) and less than 1% required conversion to Toupet fundoplication with minimal complications. Using this information, surgeons may counsel patients and colleagues to set accurate expectations and dispel common misconceptions regarding LARS.
Back to 2022 Abstracts