Abstracts
1999 Digestive Disease Week

# 4675 EFFECT OF LAPAROSCOPIC FUNDOPLICATION ON GERD-INDUCED RESPIRATORY SYMPTOMS
Marco G Patti, Massimo Arcerito, Andrea Tamburini, Carlo V Feo, Bassem Safadi, Urs Diener, Lawrence W Way, Univ of CA, San Francisco, San Francisco, CA

Background: While many studies have shown that laparoscopic fundoplication effectively controls the common symptoms of GERD (heartburn and regurgitation), the effect on respiratory symptoms (RS) is unclear. Confusion stems from difficulty preoperatively in determining whether cough or wheezing is actually caused by the reflux when reflux is found on pH monitoring. At present, there is no certain way to pinpoint a cause-and-effect relationship. Aims The goal was to assess: (a) the value of pH monitoring in establishing a correlation between RS and reflux; (b) the predictive value of pH monitoring on the results of surgical treatment; and (c) the outcome of laparoscopic fundoplication on GERD-induced RS. Patients and Methods Between October 1992 and October 1998, 340 patients underwent laparoscopic fundoplication for treatment of GERD. From the clinical findings alone, respiratory symptoms were thought possibly to be secondary to GERD in 54 pts (16%). These patients had been symptomatic for an average of 102 months, and were taking H2 blocking agents (30%) or proton pump inhibitors (70%). Median length of postoperative follow up was 26 months. Results In 22 patients a temporal correlation was found during 24-hour pH monitoring between RS and episodes of reflux. All operations were completed laparoscopically. Median length of hospital stay was 24 hours. Results are given as mean±SD. Conclusions These data show that: (a) pH monitoring is valuable in establishing a correlation between RS and reflux, and helps identifying patients most likely to benefit from antireflux surgery; (b) following laparoscopic surgery, respiratory symptoms resolved in 82% of patients when a temporal correlation between cough and reflux was found on pH monitoring, and typical symptoms resolved in 90% of patients.

	Preoperative	Postoperative	P value
Heartburn (score 0-4)*	3.3±0.8	0.3±0.7	<0.01
Regurgitation (score 0-4)*	2.6±1.2	0.1±0.3	<0.01
Cough (score 0-4)*	2.5±1.0	0.7±1.1	<0.01
Wheezing (score 0-4)*	2.4±1.0	0.6±0.9	<0.01
Reflux Score (n1<15)**	54±36	6±5	<0.05
*Cough resolved in 82% of patients in whom a correlation between cough and reflux was found during pH monitoring, but it resolved in only 57% of patients when this correlation was absent. Wheezing resolved in 65% of patients, heartburn in 85% of patients, and regurgitation in 90% of patients. ** Four patients had residual reflux on pH monitoring, two of whom remained symptomatic.

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