Quality of Life Assessment after Laparoscopic and Open Fundoplications Results of a Prospective, Clinical Study

Abstract

In the evaluation of different treatment alternatives, assessment of the patients' own perceived situation can give important clinical information in addition to the conventional efficacy variables used. Fifty patients with chronic gastroesophageal reflux disease (GERD) were operated on with either an open fundoplication (n = 25; 17 men; mean age, 51.5 years) or with a fundoplication through the laparoscope (n = 25; 16 men; mean age, 49.8 years). In each case adequate control of the GERD was achieved with the operation, also when objectively assessed. Twelve months after surgery the quality of life was studied by using a battery of self-administered questionnaires (the Psychological General Well-being (PGWB) index and the Gastrointestinal Symptom Rating Scale (GSRS), and a visual analogue scale, depicting specific reflux-related symptoms (RVAS). After antireflux surgery the overall PGWB scores were normalized with no obvious difference between the two procedures. In the GSRS scale, however, differences were shown between the two procedures, with more dyspeptic and indigestion symptoms in patients having a laparoscopic total fundic wrap. These data emphasize the clinical efficacy of antireflux surgery, with normalization of the quality of life in terms of well-being after these procedures. It should be noted that these instruments are sensitive enough to pick up significant differences between different antireflux procedures and should therefore be frequently used in the attempt to refine and optimize long-term therapeutic alternatives in reflux disease.