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A Broad Assessment of Clinical Outcomes After Laparoscopic Antireflux Surgery

Oelschlager, Brant K. MD; Ma, Kevin C. BS; Soares, Renato V. MD; Montenovo, Martin I. MD; Munoz Oca, Juan E. MD; Pellegrini, Carlos A. MD

doi: 10.1097/SLA.0b013e318254f7fe
Original Articles

Objectives: There is considerable discussion regarding “success” rates for laparoscopic antireflux surgery (LARS). We hypothesized that, in part, this was a reflection of the outcome variables used. We, therefore, defined 8 specific variables (within 3 categories) and assessed outcomes for each in a large cohort of patients.

Methods: Four hundred patients (208 women; median age 52 years old) who underwent LARS at the University of Washington from 1993 to 2008 were given a comprehensive questionnaire to assess various aspects of their outcomes from LARS. In addition, we analyzed all functional studies and all endoscopies performed in these patients in our institution, whether the patients had symptoms or not, and compared the findings to all available preoperative values.

Results: The median follow-up was 92 (6–175) months.

Conclusions: The success or failure of LARS cannot be defined in a single domain. A comprehensive analysis of outcomes requires categorization that includes symptom response, side-effects, patient's perception and objective measurement of acid exposure, mucosal integrity, and the need for additional medical or surgical treatment. Only then can patients and physicians better understand the role of LARS and make informed decisions.

This study compiles a broad array of outcomes after laparoscopic antireflux surgery (LARS) in a large cohort of patients with follow-up from 6 months to more than 15 years. The authors conclude that success or failure of LARS cannot be defined in a single domain. A comprehensive analysis of outcomes requires categorization that includes symptom response, side-effects, patient's perception and objective measurement of acid exposure, mucosal integrity, and the need for additional medical or surgical treatment.

From the Department of Surgery, University of Washington, Seattle WA.

Reprints: Brant K. Oelschlager, MD, Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA 98195. E-mail: brant@u.washington.edu

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.