Comparison of symptomatic and quality of life outcomes of laparoscopic versus open antireflux surgery

Abstract

Even though laparoscopic antireflux procedures have become the surgical treatment of choice for gastroesophageal reflux disease (GERD), little quantitative data exist comparing symptomatic and quality of life outcomes between laparoscopic and standard open procedures. This study was done to compare short-term outcomes. All patients referred for surgical treatment of GERD are prospectively followed with a disease-specific reflux symptom score (the GERD-HRQL, best score 0, worst score 50) and a generic quality of life questionnaire (the SF-36, best score 100, worst score 0). Patients are evaluated preoperatively and at least 6 weeks postoperatively. Patients were treated with either laparoscopic or open Nissen (360-degree wrap) or Toupet (270-degree wrap) fundoplications. Sixty patients underwent laparoscopic surgery (LS) and 20 open surgery (OS). LS and OS had significant improvement in the median GERD-HRQL scores, 27 to 3 and 27 to 1, respectively, both P < .000001. LS had statistically significant improvements in the SF-36 domains of mental health (62 to 71.5, P = .05) and general health (57 to 67, P = .004). There was no worsening in any of the other 6 domains. OS produced a worsening score in the domain of physical functioning (75 to 67.5, P = .02). LS had better postoperative scores compared with OS in the domains of physical functioning (80 vs 67.5, P = .05) and trended to better scores in bodily pain (64 vs 51.5, P = .09). LS produces equivalent improvement in reflux symptoms compared with OS, with improved general quality of life outcomes.