Role of fundoplication in patient symptomatology after laparoscopic antireflux surgery

Background: Symptoms following antireflux surgery are often seen as unavoidable sequelae of the operation. The aims were to determine the frequency of new adverse sequelae following antireflux surgery and the preoperative incidence of similar symptoms. Methods: Patients undergoing fundoplication underwent prospective assessment of symptoms using a structured interview before and 6 months after surgery. In addition to the presence or absence of symptoms, Visick scores, visual analogue scales and a composite dysphagia score were used. Results: Some 312 patients were evaluated. Antireflux surgery significantly diminished the symptoms of heartburn, epigastric pain, regurgitation, bloating, odynophagia, nausea, vomiting, diet restriction, nocturnal coughing and wheezing. In contrast, there was a significant increase in inability to belch, diarrhoea and increased passage of flatus. The symptoms of dysphagia, postprandial fullness or early satiety and anorexia were not significantly altered by antireflux surgery. There was, however, a group of patients who experienced new or worsened dysphagia after surgery and were more likely to do so if they had no dysphagia before surgery (31 per cent) than if dysphagia was present before surgery (19 per cent). Some 93 per cent of patients were satisfied with the overall outcome of the operation. Conclusion: The majority of patients undergoing laparoscopic fundoplication for gastro-oesophageal reflux derive symptomatic benefit and are satisfied with the outcome. Many of the so-called postfundoplication sequelae are present before surgery in many patients. Overall, antireflux surgery does not lead to increased dysphagia or bloating.