From: Reuters
Published May 20, 2008 03:15 PM

Good long-term results seen with anti-reflux surgery

NEW YORK (Reuters Health) - Five years after minimally invasive "keyhole" surgery for gastroesophageal reflux disease (GERD), most patients report near-normal health-related quality of life and are satisfied with their decision to have the surgery, new research indicates.

The results after repeat GERD surgery, however, are not as good, the researchers report in the Archives of Surgery.

GERD is a common disease in which fluid from the stomach backs up into the esophagus, typically causing heartburn and other symptoms. In addition to drugs that reduce the secretion of this acidic fluid, GERD may be treated with a type of surgery called fundoplication that tightens the junction between the esophagus and stomach.

Dr. David W. Rattner, from Massachusetts General Hospital in Boston, and colleagues mailed a survey to roughly 350 patients who had keyhole anti-reflux surgery in Boston from 1997 to 2006. Completed surveys were returned by 191 patients, who were responding an average of 5 years after surgery.

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Using an instrument specifically designed to assess GERD-related symptoms known as the GERD-HRQL, the survey showed near-normal quality-of-life scores from most respondents, who also indicated considerable satisfaction with their long-term results.

The average GERD-HRQL score (0 to 45, with 0 being no symptoms) was 5.71, which is near normal, among patients who had one anti-reflux operation. Overall, 71 percent of subjects reported being satisfied with the long-term results.

Forty-three percent of subjects used anti-reflux medications at some point after surgery, but in half of the cases, no testing was performed to confirm recurrence of GERD.

Just three patients (1.2 percent) required re-operation. Compared with other patients, these patients had worse GERD-HRQL scores, lower treatment satisfaction and higher anti-reflux medication usage rates.

"Our results indicate that, in appropriate selected patients, antireflux surgery is an excellent treatment alternative that provides very good results for patient quality of life," Rattner said in written statement.

SOURCE: Archives of Surgery, May 2008.

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