Gas-related symptoms after laparoscopic 360° Nissen or 270° Toupet fundoplication in gastrooesophageal reflux disease patients with aerophagia as comorbidity

Abstract

Background Aerophagia is a rare but well-known comorbidity in patients with gastrooesophageal reflux disease. Particularly after laparoscopic Nissen fundoplication, it has proven to result in worse symptomatic outcome and a lower postoperative quality of life in comparison to patients without preoperative gas-related symptoms. Aims Aim of the study was to compare the postoperative outcome in gastrooesophageal reflux disease patients with aerophagia as comorbidity after either laparoscopic 360° ‘floppy’ Nissen fundoplication or 270° Toupet fundoplication with main focus on the frequency and subjective impairment of gas-related symptoms. Patients and methods In 56 gastrooesophageal reflux disease patients, the comorbidity of aerophagia was diagnosed prior to laparoscopic antireflux surgery. Irrespective of their preoperative manometric findings, the patients were either scheduled to a laparoscopic 360° ‘floppy’ Nissen ( n = 28) or a laparoscopic 270° Toupet fundoplication ( n = 28). All patients have been analysed concerning the presence of gas-related symptoms preoperatively as well as 3 months after surgery. Additionally, the subjective degree of impairment was evaluated using a numerous rating scale (0 = no perception/impairment, 100 = most severe perception/impairment). The following symptoms have been analysed: ability/inability to belch, ‘gas bloat’, flatulence, postprandial fullness and epigastric pain. Results Before surgery, there were no significant differences between both surgical groups. Three months after surgery, significant differences ( p < 0.05–0.01) were found: patients who underwent a laparoscopic 270° Toupet fundoplication suffered from less impairing gas bloat, flatulence and postprandial fullness when compared with patients with a 360° ‘floppy’ Nissen fundoplication. The majority of these patients were able to belch postoperatively but felt no impairment due to this symptom. In contrast, patients of the Nissen group felt a significant impairment due to the inability to belch. Conclusion Gas-related symptoms are very common in gastrooesophageal reflux disease patients with aerophagia as a comorbidity. Patients who undergo a laparoscopic Toupet fundoplication show less impairment in relation to gas-related problems compared with patients treated with a Nissen fundoplication for a follow-up period of at least 3 months. In the Toupet group, the ability to belch postoperatively seems to be a positive aspect from the patients’ view which also improves the percentage of gas-related problems. However, long-term results are necessary.