Referral patterns and motivation for anti-reflux surgery of patients suffering from gastroesophageal reflux disease.

: Due to a better understanding of the pathophysiology of gastroesophageal reflux disease (GERD), as well as the improvements in surgical technique, the number of anti-reflux procedures has increased world-wide during the last decade. This trend has been facilitated by the advent of minimally invasive surgery. Although a great number of publications deal with the indications or selection of patients for surgery, only a few discuss the motivation of patients for choosing surgery rather than long-term medical treatment. In order to evaluate the different elements of motivation of patients suffering from primary gastroesophageal reflux disease, the data of 115 patients who had undergone anti-reflux surgery between January 1990 and June 1997 at the Department of Surgery, Technical University, Munich, were evaluated. As laparoscopic anti-reflux surgery has only been regularly performed since 1994 in our Department, the study period was divided and the two periods (1990-1993 and 1994-1997) were analyzed separately. The data were evaluated according to the referral pattern and the motivation of patients with GERD who chose surgery. In the period from 1990 to 1993, 38.5% of the patients were referred to surgery by general practitioners, 38.5% by internists, 10% by practicing surgeons and 8% by gastroenterologists. In 5% of the cases the patients themselves initiated surgery. The corresponding results for the period from 1994 to 1997 were 29%, 38%, 12%, 8% and 13%, respectively. The most common reason for a patient to choose surgery was moderate or only short-term response to appropriate conservative treatment, which accounted for 98% and 92% of the patients, respectively, during the study periods. This was followed by avoidance of life-long medical therapy and its potential risks in 77% and 85% of the patients. Fear of cancer was reported in 10% and 25%, respectively. In the second period, the option of a minimally invasive procedure was reported as an important factor in 45% of the patients. Although the number of anti-reflux procedures performed per year is increasing and there is also an increasing tendency regarding the application of minimally invasive procedures, the factors leading to referral failed to show significant differences in the two periods. The motivation of patients, however, clearly changed in favour of surgical therapy, mainly because of the availability of a minimally invasive approach.