Long-term quality-of-life assessment of gastrointestinal symptoms before and after laparoscopic Nissen fundoplication

Abstract

This was a prospective quality-of-life (QoL) assessment of gastrointestinal symptoms before laparoscopic Nissen fundoplication and during the 6-year postoperative follow-up. Over a 15-month period, 35 consecutive patients with gastroesophageal reflux disease (GERD) underwent surgery after failure of medical treatment with proton pump inhibitors. QoL was assessed using the Gastrointestinal Quality of Life Index (GIQLI) preoperatively, and at 3, 6, 12, 24, 48 and 72 months postoperatively. The preoperative GIQLI score was lower than the 'normal' score (126 points), as were the scores overall and for each dimension (social integration, physical function, emotions and gastrointestinal symptoms; all P<0.001). Also, although the GIQLI increased significantly (P<0.0001) at 3, 6, 12, 24, 48 and 72 months, it remained below normal (P<0.01). The symptom score also remained below that of the normal population (57 vs 67; P<0.0001), while the percentages of patients with abdominal pain, dysphagia, modified eating habits and belching decreased non-significantly. However, GERD symptoms were significantly reduced (51% vs 4%; P=0.01), although 20% of patients started taking proton pump inhibitors again during the follow-up period. Surgery eliminated 50% of the dysphagia symptoms reported preoperatively and, after 6 years, only 8% of patients still complained of dysphagia. Patients who undergo surgery after failure of medical treatment for GERD can expect an improved QoL, although they may not be able to achieve normal levels. Preoperative symptoms should be carefully recorded in order to better inform patients of the expected outcome following surgery.