This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Impact of symptom–reflux association analysis on long‐term outcome after Nissen fundoplication. BJS 2011; 98: 247-254.
Published: 19th October 2010
Authors: J. A. Broeders, W. A. Draaisma, A. J. Bredenoord, A. J. Smout, I. A. Broeders, H. G. Gooszen et al.
Background
A positive symptom association probability (SAP) is regarded as an important selection criterion for antireflux surgery by many physicians. However, no data corroborate the relationship between symptom–reflux association and outcome, nor is it clear what impact a negative SAP has on the outcome of antireflux surgery in patients with abnormal oesophageal acid exposure. This study compared long‐term outcomes of Nissen fundoplication in patients with a negative versus positive SAP.
Method
Five‐year outcome of Nissen fundoplication in patients with proton‐pump inhibitor (PPI)‐refractory reflux and pathological acid exposure was compared between those with (SAP+, 109) and without (SAP−, 29 patients) a positive symptom association. Symptoms, quality of life (QoL), PPI use, endoscopic findings, manometry and acid exposure were evaluated.
Results
At 5 years' follow‐up, relief of reflux symptoms (95 versus 87 per cent), reduction in PPI use (80 to 25 per cent versus 85 to 14 per cent; P < 0·050) and improvement in QoL were similar in the SAP− and SAP+ groups. Reduction in acid exposure time (13·4 to 1·6 per cent versus 11·1 to 0·2 per cent of total time; P < 0·010), improvement in oesophagitis (44 to 6 per cent versus 61 to 13 per cent; P < 0·050) and increase in lower oesophageal sphincter pressure were also comparable.
Conclusion
The subjective and objective outcomes of fundoplication in patients with pathological acid exposure are comparable among those with a positive and negative SAP. Patients with pathological acid exposure and a negative SAP can also benefit from antireflux surgery. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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