Multicenter Prospective Study of Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease in Korea

Abstract

Backgrounds/AimsThis multicenter study aims to evaluate the effect and feasibility of anti-reflux surgery compared with medical treatment for gastroesophageal reflux disease (GERD). MethodsPatients with GERD who were undergoing medical treatment with proton pump inhibitors for more than 8 weeks and those who were scheduled to undergo anti-reflux surgery were enrolled. Efficacy of pre-operative medical treatment was evaluated retrospectively and effect of anti-reflux surgery was prospectively evaluated at 1 week and 3 months after surgery. Quality of life (QOL) was also investigated before and after surgery. ResultsBetween February and October 2018, 51 patients underwent laparoscopic Nissen fundoplication for treating GERD at 5 hospitals in Korea. Thirty-four patients (66.7%) showed poor proton pump inhibitor response. At 3 months after surgery, heartburn was completely resolved in 87.9% patients and partially improved in 9.1%. Acid regurgitation was completely resolved in 82.9% and partially improved in 11.4%. Atypical extraesophageal symptoms were completely controlled in 45.5% and partially controlled in 36.4%. GERD-related QOL scores at 1 week after surgery significantly improved compared with pre-operative scores. There was no difference in GERD-related QOL scores between 1 week and 3 months after surgery. General QOL measured with European QOL-5 dimensions and health-related QOL instrument with 8 items significantly improved after anti-reflux surgery. Satisfaction with treatment was significantly higher after surgery than before surgery (72.5% vs 11.8%, P < 0.001). ConclusionAnti-reflux surgery improved GERD symptoms and QOL in patients. Anti-reflux surgery is an effective treatment option compared with medical treatment for GERD patients selected for surgical treatment. (J Neurogastroenterol Motil 2019;25:394-402)

Anti-reflux Surgery Versus Proton Pump Inhibitors for Severe Gastroesophageal Reflux Disease: A Cost-Effectiveness Study in Korea

“…The model was developed using Microsoft Excel. This study is an economic evaluation using secondary data (data that have already been collected and available from our previous researches), 14,15 therefore, informed consent could not be obtained from each patient. This study was approved by the Institutional Review Board of Kosin University Gospel Hospital (IRB No.…”

Surgical Treatment for Gastroesophageal Reflux Disease: Is It Effective Even for Asians?

“…As the authors already stated, the study by Park et al 18 has a limitation of reporting only short-term outcomes of laparoscopic Nissen fundoplication. Nevertheless, this study, which included the largest prospective cohort in Korea, may provide a better understanding of the efficacy of laparoscopic Nissen fundoplication in East Asian patients with GERD.…”

“…In this issue of the Journal of Neurogastroenterology and Motility, Park et al 18 reported a multicenter prospective study on the efficacy of laparoscopic Nissen fundoplication for GERD in Korea. In the study, antireflux surgery was found to significantly improve GERD symptoms and quality of life in patients with GERD indicated for surgical treatment.…”

Cost-effective Management of Severe Gastroesophageal Reflux Disease: Toward an Improved Understanding of Anti-reflux Surgery

“…4,5 Recently, the interest in managing GERD surgically has increased. [6][7][8] A recent randomized-controlled trial showed that laparoscopic Nissen fundoplication was superior to medication in reducing reflux-related heartburn. 6 In the study, treatment success, which was defined as an improvement of 50% or more in the GERD-Health Related Quality of Life score, was achieved in 67% of patients who underwent surgery, while 28% of patients who received active medical therapy including omeprazole and baclofen achieved treatment success.…”

“…6 In another recent study in an Asian population, laparoscopic Nissen fundoplication was shown to be effective in patients for whom medical treatment was ineffective or who were unable to discontinue medication due to symptom recurrence. 7 Although medication should be the first-line treatment for patients with GERD and even though a large proportion of patients can be medically managed, anti-reflux surgery may offer an option for selected patients. 6 The efficacy of anti-reflux surgery in the management of GERD patients is well-recognized.…”