Does the addition of fundoplication to repair the intra-thoracic stomach improve quality of life?

Abstract

The role of fundoplication in addition to hiatal hernia repair has been controversial. The aim of this study was to compare quality of life related to gastroesophageal reflux disease (GERD) in patients who underwent intra-thoracic stomach repair with and without fundoplication. We proposed that the group without a fundoplication would have poorer quality of life due to continued symptoms. All patients undergoing foregut surgery at the Creighton University Esophageal Center are entered in a prospectively maintained database. The database was queried to identify patients who underwent surgery for a near complete (>75% of stomach in chest) intra-thoracic stomach with gastric volvulus between 2004 and 2013. A questionnaire was derived from the Quality of Life in Reflux and Dyspepsia and Frequency Scale for Symptoms of GERD questionnaires to assess for symptoms related to reflux, and this questionnaire was administered by phone. A total of 150 patients underwent repair of ITSduring the study period. A total of 109 patients had ITS repair with fundoplication, while 41 had only ITS repair. Follow-up was available in 54% of patients in the fundoplication group (median follow-up of 5.2years) and in 49% of patients in the non-fundoplication group (median follow-up of 4years). Significantly, more patients woke up at night (p<0.01) and found themselves coughing around mealtime (p<0.01) in the fundoplication group. Patients in the non-fundoplication group had significantly more daytime reflux (p=0.02). Despite these symptoms, only one patient in the fundoplication group and no patients in the non-fundoplication group admitted that these symptoms were severe enough to severely affect their quality of life. All other patients contacted felt satisfied, and >80% rated their quality of life as either good or excellent. We conclude that there is not a significant difference in quality-of-life parameters on long-term follow-up between patients undergoing ITS repair with or without fundoplication.