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PRIMARY VERSUS REDO ANTIREFLUX SURGERY: AN ANALYSIS OF GERD-RELATED QUALITY OF LIFE
Mark Shacker
*2, Andrés R. Latorre-Rodríguez
1,3, Austin Reynolds
2, Sumeet K. Mittal
1,21Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ; 2Creighton University School of Medicine Phoenix Health Sciences Campus, Phoenix, AZ; 3Universidad del Rosario. Escuela de Medicina y Ciencias de la Salud, Grupo de Investigación Clínica, Bogotá D.C., Colombia
Background: Due to its notable effectiveness and low complication rates, antireflux surgery (ARS), specifically fundoplication, is the gold standard for the treatment of gastroesophageal reflux disease (GERD); however, up to 13.6% of patients may require a redo operation for failed fundoplication. Currently, there are conflicting reports regarding quality of life (QoL) outcomes among patients after redo-ARS. We sought to assess the pre- and post-operative differences in QoL between patients who underwent primary ARS (P-ARS) and those who underwent redo-ARS (R-ARS).
Methods: We retrospectively analyzed data collected in a prospective fashion from all patients who underwent benign foregut surgeries including P-ARS and R-ARS by a single experienced foregut surgeon at our center between September 2016 and July 2023. Patients who underwent other procedures, such as magnetic sphincter augmentation, EndoStim®, transoral incisionless fundoplication, or Roux-en-Y gastric bypass, were excluded from the analysis. Pre- and post-operative disease-specific QoL was evaluated using the validated GERD Health-Related Quality of Life (GERD-HRQL) questionnaire. Differences between the P-ARS and R-ARS groups were assessed using the Pearson's Chi-square test or Mann-Whitney U test as appropriate. A p-value <0.05 was considered statistically significant.
Results: From a registry of 688 patients who underwent benign foregut procedures, 437 met the inclusion criteria (female, 325 [74.4%]; mean age, 63.9±12.6 years; and mean BMI, 28.8±4.8 kg/m
2). Of these, 377 (86.3%) underwent P-ARS and 60 (13.7%) underwent R-ARS. Demographic characteristics were similar between the groups. Preoperative heartburn and regurgitation component scores were similar between the P-ARS and R-ARS groups (14.3±9.1 vs. 13.4±9.7, P=0.577 and 11.9±9.4 vs. 11.5±8.8, P=0.776, respectively). However, preoperative dysphagia was significantly worse in the R-ARS group (2.6±2.8 vs. 5.2±3.3, P<0.001). The mean follow-up of the last QoL assessment was 38.2±21.3 and 29.1±17.4 months after surgery for the P-ARS and R-ARS groups (P=0.054), respectively. Overall QoL scores improved in both groups, and there was no longer a difference in the dysphagia scores between the P-ARS and R-ARS groups (1.3±2.1 vs. 1.9±2.6, P=0.294); however, the heartburn component score was significantly higher among R-ARS patients (3.4±5.6 vs 6.0±6.7, P=0.006).
Conclusions: Disease-specific QoL (heartburn, dysphagia, and regurgitation) improved after both primary and redo-surgery. Although redo-ARS candidates reported worse dysphagia than primary ARS candidates, postoperative dysphagia scores in patients who underwent primary ARS or redo-ARS in our cohort were similar.
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