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The Durability of Laparoscopic Nissen Fundoplication: Ten Year Outcomes
Craig B. Morgenthal1, A Stival1, M D. Shane1, N A. Gletsu1, G Milam1, V Swafford1, J G. Hunter2, C D. Smith1; 1Endosurgery Unit, Emory University School of Medicine, Atlanta, GA; 2Surgery, Oregon Health and Science University, Portland, OR

BACKGROUND: Laparoscopic Nissen fundoplication (LNF) has become the most commonly performed antireflux procedure since its introduction in 1991. There are few studies with greater than 5 year outcomes. Herein we report a series of patients with a mean follow-up of 10 years. METHODS: From a prospectively maintained database, 45 patients were identified with an average follow-up after LNF of 10 years. Patient demographics and symptom scores for typical symptoms, such as heartburn (HB) and regurgitation (REG), and atypical symptoms were recorded preoperatively and at recent follow-up (0 = none, 1 = mild, 2 = moderate, 3 = severe). HB and REG were evaluated at baseline, 6 weeks, and recent follow-up to assess for durability of symptom response. Total symptom score (TSS) for each patient was summed from the 7 symptoms assessed for a maximum value of 21. Patient satisfaction and use of antireflux medication was also assessed. RESULTS: The mean follow-up was 10.2 ± 1.5 years (median 10.4 years, range 6.7 to 12.9 years). There were 28 men (62%) and 17 women (38%) with a mean age of 46.8 ± 15.1 years (range 14- 75 years) at the time of operation. The table shows symptom scores for HB and REG, the two most improved symptoms, with values expressed as percent of patients. All symptoms were significantly improved over baseline following LNF (p<0.02) except cough and asthma. The TSS at follow-up was 3.2 ± 2.8 down from 7.3 ± 2.4 at baseline, with a mean difference of -4.4 (N=26, median -5.0, range -10.8 to 0.75) per patient. The percentage of patients stating they would have the procedure again was 93.2%, while 97.3% were either satisfied or very satisfied, and 75% were off all PPI and H-2 blockers. CONCLUSION: In patients undergoing LNF, outcomes at a mean of 10 years are excellent, and the symptom response is durable. The overwhelming majority of patients are satisfied with their results and off antireflux medications. HB and REG are the symptoms most responsive to LNF, while the atypical symptoms were less so.
Symptom Scores: Heartburn and Regurgitation

 

Pre

6 wk

10 yr

HB none

11

89

64

HB mild

3

6

22

HB mod

42

0

13

HB sev

45

6

0

REG none

23

91

78

REG mild

8

9

18

REG mod

38

0

4

REG sev

31

0

0


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