Quality of life following laparoscopic Nissen fundoplication: Assessing short-term and long-term outcomes

Table 1 Baseline clinical characteristics n (%)

Follow-up	Study population (n = 249)	Long-term (n = 139)
Age, yr (mean ± SD)	51.2 ± 11.2	51.5 ± 10.6
Sex, male/female	131/118	76/62
ASA classification
I	130 (52.0)	85 (61.2)
II	96 (38.4)	40 (28.8)
III	23 (9.2)	14 (10.1)
Duration of GERD in years, median (IQR)	6 (5.0-10.0)	6 (4.0-10.0)
Preoperative medication
PPI	222 (89.2)	120 (86.3)
H2-antagonist and/or prokinetic	27 (10.8)	19 (13.7)
Duration of medical treatment, mo, median (IQR)	18 (8.0-36.0)	18 (6.0-36.0)
Preoperative Helicobacter pylori eradication	36 (14.6)	20 (14.4)
Preoperative symptom severity grade 1/2/3 as %1
Heartburn	0/49.8/48.6	0/55.4/42.4
Regurgitation	5.6/87.6/4.4	5.0/89.2/4.3
Dysphagia	12.0/9.2/0	12.9/11.5/0
pH < 4 of total time, median (IQR) as %2	12.0 (8.0-18.7)	11.5 (7.4-19.1)
DeMeester score, median (IQR)	42.5 (28.4-71.3)	41.0 (26.2-69.3)
Lower esophageal sphincter pressure in mmHg3, median (IQR)	11.0 (8.0-16.0)	11.0 (7.5-17.0)
Preoperative grading of esophagitis (Savary-Miller)
None	68 (27.3)	36 (25.9)
Grade 1 (single erosive lesion, one longitudinal fold)	22 (8.8)	16 (11.5)
Grade 2 (multiple erosive lesions, more than one fold)	98 (39.4)	57 (41.0)
Grade 3 (circumferential lesions)	13 (5.2)	3 (2.2)
Grade 4 (chronic ulcer or stricture ± Gr. 1-3)4	5 (2.0)	3 (2.2)
Grade 5 (Barrett’s esophagus ± Gr. 1-3)	43 (17.3)5	24 (17.2)6

¹DeMeester et al[18];

²24-h pH monitoring in 232 patients;

³Esophageal manometry in 228 patients;

⁴Grade 4 (4 strictures, 1 ulcer);

⁵Barrett’s esophagus only 18 (7.2%) and associated with Gr. 1-2 erosive changes in 24 patients (9.6%) and grade 3 in 1 (0.4%);

⁶Barrett’s esophagus only 10 (7.2%) and associated with Gr. 1-2 erosive changes in 14 patients (10.1%). GERD: Gastroesophageal reflux disease; PPI: Proton pump inhibitor; IQR: Interquartile range.

Table 2 Operative data and short-term surgical outcome n (%)

	n = 249
Type of surgery
Floppy Nissen fundoplication	213 (85.5)
Rosetti-Hell fundoplication	36 (14.5)
Hiatoplasty	235 (94.4)
Conversion to open surgery1	7 (2.8)
Operation time, min, median (IQR)	90 (70.3-135.0)
Mortality (30 d)	0 (0.0)
Intraoperative complications	3 (1.2)
Esophageal perforation	2 (0.8)
Burn injury of the fundus	1 (0.4)
Postoperative morbidity (30 d)2	19 (7.6)
General	12 (4.8)
Atelectasis + fever	5 (2.0)
Pneumonia	7 (2.8)
Surgical	9 (3.6)
Pleural empyema	1 (0.4)
Fundic perforation (burn injury)	1 (0.4)
Port-site hernia and bowel obstruction	1 (0.4)
Port-site bleeding	2 (0.8)
Excessive pain at port-site	1 (0.4)
Gastric dilatation	1 (0.4)
Wound infection	1 (0.4)
Urinary retention	1 (0.4)
Reoperation rate3	5 (2.0)
Relaparotomy	4 (1.6)
Thoracotomy and decortication	1 (0.4)
Postoperative hospital stay, d, median (IQR)	2 (2-3)

¹Reasons for conversion: intraoperative esophageal perforation (n = 1), technical difficulties in dissection (n = 4), obesity (n = 1), problem with CO₂-insufflation (n = 1);

²Figures in the column include some patients with more than one complication;

³Reoperations: bowel obstruction (n = 1), fundic perforation (n = 1), port-site bleeding (n = 2), thoracotomy and decortication for pleural empyema (n = 1). IQR: Interquartile range.