GASTROESOPHAGEAL REFLUX SURGERY RESULTS

Risks or complications that have been associated with fundoplication include:
• heartburn recurrence
• swallowing difficulties caused by an overly tight wrap of the stomach on the esophagus
• failure of the wrap to stay in place so that the LES is no longer supported
• normal risks associated with major surgical procedures and the use of general anesthesia
• increased bloating and discomfort due to a decreased ability to expel excess gas Complications, though rare, can occur during fundoplication. These complications can include injury to such surrounding tissues and organs, as the liver, esophagus, spleen, and stomach. One of the major drawbacks to fundoplication surgery, whether it is open or laparoscopic, is that the procedure is not reversible. In addition, some of the symptoms associated with complications are not always treatable. One study showed that about 10% to 20% of patients who receive fundoplication have a recurrence of gastroesophageal reflux disease symptoms or develop such other problems, as bloating, intestinal gas, vomiting, or swallowing problems following the surgery. In addition, some patients may develop altered bowel habits following the surgery.

Normal results
One research study found that fundoplication is successful in 50% to 90% of cases. This study found that successful surgery typically relieves the symptoms of gastroesophageal reflux disease and esophagus inflammation (esophagitis). The researchers in this study, however, provided no information on the long-term stability of the procedure. Fundoplication does not always eliminate the need for medication to control gastroesophageal reflux disease symptoms. A different study found that 62% of patients who received fundoplication continued to need medication to control reflux symptoms.

However, these patients required less medication than before fundoplication. Two studies demonstrated that laparoscopic fundoplication improved reflux symptoms in 76% and 98% of the treated populations, respectively. In an additional study, researchers evaluated 74 patients with reflux disease who received Nissen fundoplication after failure of medical therapy. The researchers concluded that 93.8% of the patients had complete resolution of symptoms and did not require anti-reflux medications approximately 14 months after fundoplication. Researchers have found that when fundoplication is successful, the resting pressure in the LES increases. This increase reflects a return to more normal LES functioning where the LES keeps stomachacid in the stomach through increased pressure.

Overall, studies have suggested that the vast majority of patients who receive laparoscopic reflux surgery have positive results. These patients are either symptom-free or have significant improvements in reflux symptoms. The laparoscopic approach has a few advantages over other forms of fundoplication. These advantages include:
• decreased postoperative pain
• more rapid return to work
• decreased hospital stay
• better cosmetic results

Morbidity and mortality rates
Mortality is extremely rare during or following fundoplication. Complications and side effects are not common following fundoplication, especially using the laparoscopic approach, and are usually mild. A review of 621 laparoscopic fundoplication procedures performed in Italy found no cases of mortality and complications in 7.3% of cases. The most serious complication was acute dysphagia (difficulty swallowing) that required a re-operation in 10 patients. In general, long-term complications resulting from this procedure are uncommon.

Alternatives
There are several variations of fundoplication that may be performed. In addition, laparoscopic fundoplication may require conversion to an open, or traditional, surgical fundoplication in a small percentage of cases. The most common alternative to fundoplication is simply a continuation of medical therapy. Typically, patients receive medication for a period prior to being evaluated for surgery. A review of nine studies found that omeprazole, a proton-pump inhibitor, was as effective as surgery. This same review, however, found that the other commonly used anti-reflux drugs, histamine H2-antagonists, were not as effective as surgery.