Complications within the First 24 Hours following Cleft Lip Repair: A Justification for Overnight Observation

Abstract

A strong link exists between gastroesophageal reflux disease (GERD) and airway disease. We sought to determine the long-term results of laparoscopic antireflux surgery (LARS) for multiple airway symptoms of GERD. Methods: Between 12/15/1993 and 12/21/2002, 750 patients underwent LARS at the University of Washington. Of these patients, 230 (31%) experienced cough, hoarseness, or wheezing more than once per week and had failed medical management. We attempted to contact each patient and succeeded in 136 patients (59%). At a median follow-up of 53 months (range 19-110 mo) we determined frequency and severity of airway symptoms (cough, hoarseness, wheezing, sore throat, dyspnea), esophageal symptoms (heartburn, regurgitation, dysphagia), anti-acid medication usage, happiness with surgery, and rating of operative treatment. Results: Airway symptoms improved in the majority of patients (Table ). Typical GERD symptoms (heartburn, regurgitation) improved in 87-93% of patients. Preoperatively, almost all patients (98%) used prescription medical therapy. Forty-five patients (33%) continue to use daily prescription medication. The majority of patients (88%) were happy with the operative treatment, which was rated excellent by 78 patients (57%) and good by 33 patients (24%). Symptom Number of Patients % Pts Improved Pre-Op Freq Score* Post-Op Freq Score* p-value (Mean [138} SD) (Mean Ϯ SD) Cough 108 74 3.51 Ϯ 0.65 1.58 Ϯ 1.62 0.001 Hoarseness 82 66 2.93 Ϯ 1.09 1.45 Ϯ 1.54 0.001 Wheezing 37 69 2.86 Ϯ 1.13 1.46 Ϯ1.52 0.001 Sore Throat 41 70 2.56 Ϯ 1.10 1.10Ϯ 1.36 0.001 Dyspnea 31 65 2.84 Ϯ 1.00 1.97 Ϯ 1.66 0.01 *Frequency score: 0= never, 1= once/month, 2= once/week, 3= once/day, 4= several/day Conclusions: LARS provides long-term relief of airway symptoms in over two-thirds of patients with associated abnormal GERD, and in 90% of patients with typical symptoms of GERD. LARS should be considered for patients with proven GERD and cough, hoarseness, or wheezing, especially when medical management has failed.