Elsevier

Surgery

Volume 138, Issue 4, October 2005, Pages 612-617
Surgery

Central Surgical Association
Efficacy of laparoscopic fundoplication in controlling pulmonary symptoms associated with gastroesophageal reflux disease

https://doi.org/10.1016/j.surg.2005.07.013Get rights and content

Background

Gastroesophageal reflux disease (GERD)–induced pulmonary symptoms (PS) can be difficult to control. The effectiveness of laparoscopic fundoplication (LF) in controlling PS among patients with medically recalcitrant GERD is poorly documented. We evaluated our results in controlling important PS in patients with GERD undergoing LF.

Methods

Seventy-four patients (28 men, 46 women) were identified with clinically important PS from a prospective cohort of 155 patients undergoing elective LF for recalcitrant GERD. Median age was 52.5 years (range, 29-84 years). Sixty-seven (91%) patients were taking proton pump inhibitors at the time of operation. Quality of life by using the SF36 physical (PCS) and mental (MCS) component summary scores (normal, 50) and heartburn severity by using the health-related quality of life (HRQOL) (best score, 0; worst score, 45) were measured.

Results

All 74 patients with PS survived operation, and minor morbidity occurred in 5 (7%) patients. Median hospital stay was 2 days (range, 1-6 days), and return to normal activity was seen at 2.2 weeks (range, 1-8 weeks). Median follow-up was 12 months. PS were improved significantly (P < .01) for hoarseness (62% to 17.6%), bronchospasm (60% to 9.5%), and aspiration (22% to 1.4%). Before LF, 11 (14.9%) patients required bronchodilators or oral steroids. Postoperatively such therapy was required in only 3 (4.2%) patients (P = .019), with no patient requiring oral steroids. Patients with poorer control of their GERD on the basis of high HRQOL scores had significantly more PS after operation.

Conclusions

A significant number of patients with medically recalcitrant GERD (46% from our prospective database) have important PS. LF can improve PS, decrease requirement for pulmonary medications, as well as improve typical reflux symptoms and quality of life.

Section snippets

Materials and methods

From June 1999 to March 2002, 155 patients undergoing LF enrolled in our study. Seventy-four (46%) of these patients reported chronic pulmonary symptoms that were mild in most cases, and they are the cohort discussed in this report. There were 28 men and 46 women. Median age was 52.5 years (range, 29-84 years). All patients were referred for operation primarily complaining of typical symptoms of GERD such as heartburn, regurgitation, and water brash. All 74 patients were found to have pulmonary

Surgical outcomes

All 74 patients underwent Nissen fundoplication. There were no partial fundoplications in the series and no perioperative deaths. Morbidity occurred in 5 (7%) of patients and included pneumothorax (n = 1), atrial fibrillation (n = 1), pneumonia (n = 1), superficial wound infection (n = 1), and pleural effusion (n = 1). Median length of stay was 2 (range, 1-6) days. Median time to return to normal activity was 2.25 (range, 1-8) weeks. Median follow-up was 12 (range, 1-36) months.

Symptoms

Typical symptoms

Discussion

Although several investigators have reported on a link between pulmonary diseases and GERD, it is rare to see patients with chronic pulmonary symptoms undergoing diagnostic evaluation for GERD in clinical practice. In part this might be explained by the different perspectives and training of pulmonary and gastrointestinal physicians. A second factor might be that the etiology of respiratory symptoms is not clearly understood and that different mechanisms might be accounting for respiratory

References (21)

There are more references available in the full text version of this article.

Cited by (28)

  • Anti-reflux surgery for controlling respiratory symptoms of gastro-esophageal reflux disease: A systematic review and meta-analysis

    2021, Asian Journal of Surgery
    Citation Excerpt :

    For estimating NNH, the present review included any postoperative complications; for estimating NNT, the present review considered the improvement of respiratory symptoms. Of the 3,424 initially screened articles, 68 13–80studies were included for systematic review and 6113–23,25-34,36,38–40,42-76,80 were included for meta-analysis, with a cumulative sample size of 3,869 patients. The PRISMA flow-chart has been reported in Fig. 1.

  • Extraesophageal Symptoms and Diseases Attributed to GERD: Where is the Pendulum Swinging Now?

    2018, Clinical Gastroenterology and Hepatology
    Citation Excerpt :

    Concern about using antireflux surgery in extraesophageal reflux is a high risk-to-benefit ratio using this treatment option given the lack of robust evidence for its benefit. Most surgical data in chronic cough,110–112 LPR,113–121 and asthma39,72,122–127 are uncontrolled, retrospective, and suffer from small sample sizes. Despite enthusiasm from observational and case series reporting improvement of extraesophageal reflux symptoms, most surgeons shy away from offering fundoplication to patients with extraesophageal reflux symptoms without typical heartburn and/or regurgitation.

View all citing articles on Scopus

Presented at the 62nd Annual Meeting of the Central Surgical Association, Tucson, Arizona, March 10-12, 2005.

View full text