Evaluation of Clinical Outcome after Laparoscopic Antireflux Surgery in Clinical Practice: Still a Controversial Issue

Abstract

Background. Laparoscopic antireflux surgery has shown to be effective in controlling gastroesophageal reflux (GERD). Yet, a universally accepted definition and evaluation for treatment success/failure in GERD is still controversial. The purpose of this paper is to assess if and how the outcome variables used in the different studies could possibly lead to an homogeneous appraisal of the limits and indications of LARS. Methods. We analyzed papers focusing on the efficacy and outcome of LARS and published in English literature over the last 10 years. Results. Symptoms scores and outcome variables reported are dissimilar and not uniform. The most consistent parameter was patient's satisfaction (mean satisfaction rate: 88.9%). Antireflux medications are not a trustworthy outcome index. Endoscopy and esophageal manometry do not appear very helpful. Twenty-four hours pH metry is recommended in patients difficult to manage for recurrent typical symptoms. Conclusions. More uniform symptoms scales and quality of life tools are needed for assessing the clinical outcome after laparoscopic antireflux surgery. In an era of cost containment, objective evaluation tests should be more specifically addressed. Relying on patient's satisfaction may be ambiguous, yet from this study it can be considered a practical and simple tool.

Prevalence of Pediatric Aspiration-Associated Extraesophageal Reflux Disease

“…Postoperative outcome measurements are also not always objective and consistent; therefore, determining the success of surgery is sometimes difficult, and few studies have been performed. 25 Although our results demonstrate a high prevalence of pepsin-positive samples, we were unable to identify any specific clinical factors that may predict which patients are more likely to have silent aspiration events. In the absence of any specific factors, pepsin testing of BAL fluid samples-which seems to have a high positive predictive value-may be a feasible means to identify these patients.…”

“…24 Postoperative outcome measurements are also not always objective and consistent, therefore determining the success of surgery sometimes difficult. 25 …”

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

“…One third of patients, submitted to fundoplication, is reported to take acid-lowering compounds (mostly PPIs) after ARS, but only few studies have specified whether drug use was on a regular or occasional basis [76]. A meta-analysis of randomized controlled trials (RCTs) [77] found that – after ARS – 14 % of patients still require antisecretory drugs.…”

“…Although medication use is often considered as an outcome measure for successful ARS, some studies have shown that antisecretory drug use does not correlate with true recurrent reflux in most patients [76] and does not necessarily indicate a failure of the procedure. A significant proportion of patients taking medications after operation are using them to relieve non-reflux symptoms and only one third of patients displays an abnormal esophageal exposure to acid after surgery [76].…”

“…A significant proportion of patients taking medications after operation are using them to relieve non-reflux symptoms and only one third of patients displays an abnormal esophageal exposure to acid after surgery [76]. Therefore, many patients take PPIs despite the lack of objective evidence of GERD on esophageal testing.…”