PTU-195 Six years of laparoscopic Nissen's fundoplication, was it worth it? An audit of 100 patients: Abstract PTU-195 Table 1

Abstract

Introduction: Nissen's fundoplication for gastro-oesophageal reflux disease provides good long term control of acid reflux but is often not without unwanted side-effects. We investigated long term outcome of Nissen's fundoplication at our centre. Method(s): Study group included 100 patients who underwent Nissen's fundoplication from 2005 to 2011 at our unit. Pre-operative demographics, symptom profile, investigations and operative data were reviewed. Symptoms after surgery (heartburn, dysphagia, bloating and excessive flatus), antacid usage and patient satisfaction were assessed using a follow-up questionnaire. Result(s): Average patient age was 47.5 years (19-79 years) with male to female ratio of 57:43. Majority of patients were obese or overweight (79%). Average follow-up was 39 months (3-80 months). Main symptoms included acid reflux (99%), volume reflux (56%) and nocturnal and postural reflux (45%). Gastroscopy revealed hiatus hernia 92%, reflux oesophagitis 71% and Barrett's oesophagus 11%. pH studies and manometry were undertaken in 90% and 93% of patients respectively. Mean acid exposure time was 16.2% (median 13%, range 1.4%-86%), mean symptom index was 79.25% (median 91%, range 1-100%) and mean Demeester score was 50.51 (median 30, range 4.7-291). Lower oesophageal sphincter pressure was normal in 54%, low in 37% and high in 9% of patients with complete relaxation in 91%. No patient had significant oesophageal dysmotility. No routine follow-up pH studies were undertaken. A primary crural repair with 360degree short and floppy fundal wrap was constructed on all the patients. Hiatus was prosthetically reinforced on 17 patients (collagen patch 12, mesh 5). Conversion to open surgery was 2% (splenic bleed, difficult anatomy). Four patients required further surgery during follow-up period (severe dysphagia 2, excessive flatus 1, herniation through the wrap 1). Questionnaire responses from 96/100 patients were analysed (postal 56, telephonic 22, clinic review 18). Most patients (81%) were happy to have undergone surgery and would recommend this procedure to a friend (79%). A total of 58 patients (60%) were not on any anti-acid drugs, however 17 patients (18%) were on regular PPIs. Frequencies of post-operative symptoms are detailed below. Overall outcome was described by patients as excellent 43%, good 38%, fair 11% and poor 8%. Conclusion(s): Majority of patients undergoing Laparoscopic Nissen's fundoplication had good long term control of acid reflux and were happy with their decision to undergo surgery. Wind related side effects are a significant cause for dissatisfaction and must be emphasised during decision making for surgery.