217. LAPAROSCOPIC FUNDOPLICATION EFFECTIVE IN TREATING REFLUX MICRO-ASPIRATION

Abstract

Abstract Pulmonary micro-aspiration has become increasingly recognised subtype of severe gastro-oesophageal reflux disease (GORD). Acid suppression can help with symptoms in proportion of patients, however, does not reduce pulmonary contamination with gastric content. Laparoscopic fundoplication was found to be effective in reducing rates of reflux micro-aspiration. The aim of this study was to examine outcomes of surgical treatment of GORD in patients with confirmed reflux micro-aspiration on novel reflux scintigraphy. Data was extracted from prospectively populated single centre database. Patients with confirmed reflux aspiration by validated novel protocol scintigraphy and treated with laparoscopic 360-degree Nissen fundoplication between 2006–2018 were included. Primary outcome was resolution of reflux micro-aspiration on post-operative scintigraphy. Secondary outcomes included manometry and scintigraphy findings associated with ongoing aspiration, surgical complications, and patient-reported quality of life outcomes. Inclusion criteria were met by 159 patients (66% female); average age 58 (SD 14, range 18–88). Most common presenting symptoms were regurgitation and cough. Laparoscopic fundoplication was associated with resolution of reflux micro-aspiration in 138 (86.8%) of patients. Strongest predictors of persistent aspiration following surgery were severe ineffective oesophageal motility (p = 0.001) and reduced oesophageal clearance (p = 0.003). Complications (Clavien-Dindo grade III and above) occurred in 4 patients (2.5%). There was no perioperative death in this cohort. Patient satisfaction rate with surgery was 94%. Laparoscopic fundoplication is effective in treating reflux micro-aspiration with best outcomes observed in patients with normal oesophageal motility and good oesophageal clearance.