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Surgical Endoscopy

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01-11-2007

Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes

Authors: Craig B. Morgenthal, Edward Lin, Matthew D. Shane, John G. Hunter, C. Daniel Smith

Published in: Surgical Endoscopy | Issue 11/2007

Abstract

Background

A small but significant percentage of patients are considered failures after laparoscopic Nissen fundoplication (LNF). We sought to identify preoperative predictors of failure in a cohort of patients who underwent LNF more than 10 years ago.

Methods

Of 312 consecutive patients undergoing primary LNF between 1992 and 1995, recent follow-up was obtained from 166 patients at a mean of 11.0 ± 1.2 years. Eight additional patients who underwent reoperation were lost to follow-up but are included. Failure is broadly defined as any reoperation, lack of satisfaction, or any severe symptoms at follow-up. Potential predictors evaluated included sex, age, body-mass index (BMI), response to acid reducing medications (ARM), psychiatric history, typical versus atypical symptoms, manometry, esophageal pH, and others. Logistic regression was used to assess significance of predictors in univariate analysis.

Results

Of 174 known outcomes, 131 were classified as successful (75.3%), while 43 were failures (24.7%): 26 reoperations, 13 unsatisfied, and 13 with severe symptoms. Response and lack of response to ARM were associated with 77.1% and 56.0% success rates respectively (P = 0.035). Eighty five percent of patients with typical symptoms had a successful outcome, compared to only 41% with atypical symptoms (P < 0.001). Preoperative morbid obesity (BMI > 35 kg/m²) was associated with failure (P = 0.036), while obesity (BMI 30–34.9 kg/m²) was not. A history of psychiatric illness trended toward significance (P = 0.06).

Conclusions

In a cohort with 11 years follow-up after LNF, factors predictive of a successful outcome include preoperative response to ARM, typical symptoms, and BMI < 35 kg/m². Patients with atypical symptoms, no response to ARM, or morbid obesity should be informed of their higher risk of failure. Some patients in these groups do have successful outcomes, and further research may clarify which of these patients can benefit from LNF.

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Title: Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes
Authors: Craig B. Morgenthal
Edward Lin
Matthew D. Shane
John G. Hunter
C. Daniel Smith
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 11/2007
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-007-9490-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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