Upper GI 09

Aims: This study compares the outcome of three different techniques of antireflux surgery, carried out at three regional specialist units. Methods: Patients undergoing open Nissen fundoplication (Newcastle (ON), n = 76), laparoscopic Nissen fundoplication (Edinburgh (LN), n = 119), and laparoscopic Watson fundoplication (Aberdeen (LW), n = 254) between December 1993 and February 2001 were identified from prospectively compiled databases. Patients were sent a questionnaire, including two gastrointestinal symptom scores (DeMeester and Gastrointestinal Symptom Rating Scale (GSRS)). Results: A total of 357 (80.6 per cent) patients completed questionnaires; no differences in response rate were observed among centres. Median time since surgery was 3.8 years for LW group, 2.4 years for LN group and 3.5 years for ON group (P < 0.001). Only a mean of 6.5 per cent patients reported a poor outcome. DeMeester score (GORD symptoms) was highest following LW and lowest following LN (P = 0.009), and increased with time from operation. However, logistic regression revealed no difference among the procedures after allowing for the effect of time, suggesting that time since operation is important, not procedure type. Overall, LN patients reported greater inability to belch (P = 0.007), however, this symptom also improved over time (r = −0.14, P = 0.009), and there was no difference among groups after taking time since operation into account. In addition there was no significant difference in the GSRS scores, painful bloating or inability to vomit between groups. Conclusion: This study has confirmed that the long-term outcome following all three procedures is similar with gradual reduction in inability to belch with time and some recurrence of other GORD symptoms.