Gastric Emptying as a Prognostic Factor for Long-term Results of Total Laparoscopic Fundoplication for Weakly Acidic or Mixed Reflux

Abstract

To evaluate the long-term effect of laparoscopic total fundoplication (LTF) on symptoms and reflux control in patients with combined (acidic and weakly acidic) (CR) or weakly acidic reflux (WAR), according to the gastric emptying (GE) rate. After LTF, 12% to 15% of patients experience persistent reflux symptoms and 20% and 25% develop gas-related symptoms. Both WAR and inability to belch have been suggestive of these symptoms. Consecutive patients with CR and WAR selected for LTF were included in a prospective clinical study. Gastroesophageal function was assessed by clinical validated questionnaires, upper endoscopy, esophageal manometry, and 24-hour impedance-pH monitoring before and 12 and 60 months after LTF. Gastric scintigraphy was preoperatively performed in all patients to evaluate GE. This trial is registered with ClinicalTrials.gov (no. NCT01741441). Between June 2002 and June 2007, a total of 188 patients with CR and WAR underwent LTF; 172 (91.5%) completed the 5-year protocol. Among them, 42 (24.4%) had preoperative mild/moderate delayed GE (DGE). Quality of life at 12 and 60 months improved in patients with normal GE (Gastroesophageal Reflux Disease Health-Related Quality of Life score 18.2/2.5, P < 0.001; Health-Related Quality of Life score from 52.1 to 68.3, P < 0.001) but not in DGE patients. Manometric values of "gastroesophageal junction" significantly increased at 12 and 60 months in all patients with normal GE, whereas the values returned to the baseline at 60 months in 66.7% of DGE patients. Acidic and liquid reflux episodes significantly reduced in both groups, whereas a significant reduction of WAR and mixed (gas + liquid) reflux episodes occurred only in patients with normal GE (P < 0.001). DGE affects long-term results of LTF in CR and WAR patients.