The outcome of laparoscopic antireflux surgery in relation to patients' subjective degree of compliance with former antireflux medication.

Abstract

It is well known that several patient-related factors are able to affect the surgical outcome such as quality of life or symptom relief after laparoscopic antireflux surgery. The aim of the current study was to evaluate and compare surgical outcome up to 1 year after laparoscopic antireflux surgery in relation to patients' subjective degree of compliance with former antireflux medication. Based on a three-level grading of subjective compliance with primary antireflux medication, a total of 140 patients undergoing antireflux surgery were divided into three subgroups: group 1/TC (totally compliant; n = 60), group 2/PC (partially compliant; n = 49); and group 3/NC (noncompliant; n = 31). Gastrointestinal Quality of Life Index (GIQLI), satisfaction with surgery, and the subjective degree of dysphagia as well as traditional outcome data (e.g., DeMeester score, lower esophageal sphincter pressure, side effects) were evaluated in all patients. As a result of surgery, only patients out of group 1/TC (GIQLI, preoperative 86.3 + 9.3 vs. 1 year postoperatively 123.1 + 7.2 points) and group 2/PC (GIQLI, preoperative 94.2 + 8.6 vs. 1 year postoperatively 120.8 + 7.8 points) showed a significant quality of life improvement that remained stable for at least 1 year (P < 0.05-0.01). In contrast, group 3/NC (GIQLI, preoperative 100.2 + 6.1 vs. 1 year postoperatively 117.2 + 9.8 points) patients had no significant quality of life improvement and patient satisfaction with surgery was less good when compared with that of the other groups. In these patients, also the subjective degree of postoperative dysphagia was significantly (P < 0.05-0.001) higher during the 1-year follow-up when compared with patients from group 1/TC or group 2/PC. A total of 42% of group 3/NC patients reported surgical side effects, whereas only 3% from group 1/TC and 10% from group 2/PC stated to be affected by any new symptoms (P < 0.0001). None of group 1/TC or group 2/PC patients suffered from recurrent symptoms or underwent laparoscopic reoperation. Of group 3/NC, a total of four patients (13%) needed any kind of additional intervention in relation to antireflux surgery (reoperation, n = 3; pneumatic dilatation, n = 1). There were no significant differences between the three groups when postoperative values of esophageal manometry and 24-hour pH monitoring were compared. What the current study does show is that the efficacy and the surgical outcome after laparoscopic antireflux surgery partly depends on the subjective degree of patient compliance with primary antireflux medication. Patients with no compliance in relation to former antireflux medication should generally not be refused antireflux surgery. But these patients should be evaluated with great care before surgery and should also be informed that surgical outcome may be affected in several aspects.