Is Laparoscopic Anti-Reflux Surgery Effective in Patients with Atypical Gastroesophageal Reflux Symptoms and Small Sliding Hiatus Hernias in the Longterm?

Abstract

Aim: The primary objective was to assess the long-term outcomes in patients undergoing laparoscopic anti-reflux surgery in our hospital. The secondary objective was to identify risk-factors for unsatisfactory outcome. Method(s): Retrospective review of electronic records of patients admitted for anti-reflux surgery at our hospital between January 2016 and December 2020. Demographics, symptoms, comorbidities, pre-operative investigations, operative procedure, findings and outcomes were recorded. Persistence or recurrence of symptoms with use of PPIs was considered an unsatisfactory outcome. Binary logistic regression analysis was performed in R. Result(s): Seventy patients, 51.4% female, age 50.76+-16.23 years, underwent laparoscopic anti-reflux surgery during the study period. The BMI was 29.19+-4.83 and the Charlson Co-morbidity Index 2,0-4]. Sixty-three patients (90%) experienced typical reflux symptoms and 28/70 (40%) atypical symptoms. Six patients (8.57%) presented with atypical symptoms only. Thirty-four (48.5%) experienced dysphagia pre-operatively. Pre-operative investigations, including OGD, CT, barium-swallow and physiology-studies revealed hiatus hernia in 66 (94.2%), oesophagitis in 34 (48.6%) and Barrett's oesophagus in 5 (7.1%). Sixty-two patients (88.6%) underwent partial-fundoplication, 5 (7.1%) total-fundoplication and 3 (4.2%) gastropexy. After a median follow up of 7.6 years, 14 (20%) patients experienced an unsatisfactory outcome. There were no revision operations. Atypical symptoms (OR:3.5 95CI: 1.02-11.09, p=0.0048) and sliding hiatal hernias <3cm (OR: 7.3, 95CI:2.1-25.5, p=0.0018) were associated with unsatisfactory outcome. Conclusion(s): In comparison to the published literature, our data suggest encouraging long-term outcomes. Nevertheless, 1/5 patients experienced limited benefit from the operation in the long-term. Patients with atypical symptoms and sliding hiatal hernias < 3cm are more likely to fall in this category.