WTP5.9 Does anti-reflux surgery offer durable symptom remission in a tertiary centre?

Abstract

Abstract Aims Anti-reflux surgery success can be affected by multiple factors. We sought to evaluate pre-operative and technical factors influencing medium-term outcomes. Methods A retrospective analysis of laparoscopic anti-reflux surgery in a tertiary centre between 2016 and 2019. Patients were identified through clinical coding. Electronic patient records were reviewed with minimum follow up of 3 years. Outcomes analysed included pre-operative work-up, type of fundoplication, remission and relapse of symptoms at follow up and revision surgery. Results 104 patients underwent fundoplication. The majority were Nissen 68 (65%) and the remaining were partial wrap configuration.18 (19%) of these patients were revisional anti-reflux procedures. Pre-operative investigations noted most underwent endoscopy 85 (81.7%) and oesophageal physiology in 74 (71.2%) with barium swallow in 34 (32.7%). 15/104 (14%) underwent all three studies. 50 (48.1%) patients were symptomatic at initial follow up with dysphagia (21.3%) and dyspepsia (13.5%) most prevalent. Of these 104 patients, 15 (14.4%) required revisional surgery. 6/36 (17%) partial and 9/68 Nissen (13.2%) fundoplications underwent re-operation. Timing of revision varied: 8 (53.3%) within one year including early 30-day re-operation for complications. 3 (20%) at 1-3years and 4 (26.7%) after 3 years. Subsequent revision rate was higher for revisional patients: 4/18 (22.2%) compared to primary 11/86 (12.7%). Conclusion Almost half of the patients had at least one symptom at initial follow up, however only 14.4% patients required revisional surgery by 3 years follow up. Partial fundoplication and previous fundoplication surgery had higher revision surgery rates.