Quality of life following laparoscopic nissen fundoplication: outcome at 20 years

Purpose: Laparoscopic Nissen fundoplication remains a vital treatment
modality for patients with medication-refractory or severe symptomatic
GORD. Since its rapid adoption during the early 1990s, multiple studies
have published QOL outcomes following 10 years of follow-up, however
little data exists beyond this period. This study investigated the ultra-long
term (20-year) QOL outcomes of the procedure.
Methodology: Demographic and clinical data from patients undergoing
laparoscopic Nissen fundoplication for GORD at Adelaide hospitals was
prospectively entered into a surgical database. A patient group was identified
where the primary surgery had been undertaken more than twenty years
prior and were not previously lost to follow-up. Each participant was invited
to complete both the RAND Short-Form 36 and GERD-Health Related
Quality of Life (HRQL) questionnaires by mail.
Results: 253 patients who underwent surgery between January 1992 and
December 1996 were invited to participate. Completed SF-36 and HRQL
surveys were returned by 131 (52%) and 125 (49%), respectively. Following
mean follow-up of 264 months (SD 16.3), average total heartburn score
for the HRQL instrument was 6.2 (SD 11) with 82% remaining satisfied
with surgery outcome. Mean SF-36 scales for physical (68, SD 31) and
emotional functioning (76, SD 19) were slightly less than age-adjusted local population data, 70 and 82 respectively. No scale correlated with patientrated
surgical outcome.
Conclusion: Laparoscopic Nissen fundoplication has high patient satisfaction
at 20 years follow-up. SF-36 instrument QOL scales remain slightly
lower post-fundoplication than local population data but correlate poorly
with patient-rated surgical outcome.