Quality of Life Assessment After Laparoscopic Fundoplication: Results of a Prospective Clinical Study

Abstract

Background: In the evaluation of different treatment alternatives for chronic gastroesophageal reflux disease (GERD), assessment of the patient's own perceived situation can give important supplementary clinical information to the conventional efficacy variables. Patients and methods: We have consecutively studied 50 patients with GERD who were referred for antireflux surgery and were operated on either with open fundoplication (n = 25) or fundoplication through the laparoscope (n = 25). In each case, an adequate control of GERD was achieved by the operation, also when objectively assessed. All patients were examined with respect to Quality of Life 12 months after surgery. Quality of Life was studied by the use of self-administered questionnaires, where the Psychological General Well-Being Index (PGWB), the Gastrointestinal Symptom Scale (GSRS) and the Reflux Visual Analogue Scale (RVAS) were used. The laparoscopically operated patients were also studied 6 months postoperatively in order to elucidate the early consequences of surgery. Results: Twelve months after successful antireflux surgery, PGWB scored 104+13 (SE) among those operated on by an open procedure, which was very similar to the values 96 ± 27 noted among those operated on through the laparoscope (NS). There was a slight difference in some PGWB variables, however, which reached statistical significance in favour of the open-operated patients in terms of depressed mood dimension, fear of losing control and concerned about health (p < 0.05). When the outcome of the GSRS scores was analysed we obtained a value of 26 ± 5 in the open group and 37 ± 18 in the laparoscopy group. This difference attained statistical significance with respect to symptoms associated with dyspeptic and bowel dysfunction syndrome (p < 0.05). When Quality of Life data were recorded at both 6 and 12 months postoperatively no difference in scores was revealed. Conclusion: These observations emphasize the clinical efficacy of antireflux procedures irrespective of whether they are done through a laparotomy or through the laparoscope, with normalization of Quality of Life. It should be noted, however, that these Quality of Life instruments are sensitive enough to pick up significant differences between different antireflux procedures. In the open-operated group nine patients had a Toupet fundoplication, which is known to be followed by less postfundoplication symptoms of a bloating or flatulence character. In the laparoscopically operated patients all had a total fundic wrap. Therefore, these Quality of Life instruments should be frequently used in attempts to refine and optimize long-term therapeutic alternatives in chronic GERD.

Key Words:

• Fundoplication
• QOL
• reflux disease