Quality of life before and after laparoscopic fundoplication. Does quality of life depend on psychological factors? Preliminary report.

UNLABELLED: Gastroesophageal reflux disease (GERD) is the most common benign foregut disorder. In many cases multiple factors contribute to the development of esophagitis and result in GERD symptoms. GERD has a definite negative impact on patients' quality of life. The aim of this study was to assess the postoperative results and compare pre- and postoperative quality of life after laparoscopic Nissen or Toupet fundoplication and also to determine if psychological factors have an influence on the quality of life and surgical outcome. MATERIAL AND METHODS: Fifty patients with a proven GERD and hiatal esophageal hernia (HHE) were included in a prospective study. After routine examinations, assessment of quality of life (Gastrointestinal Quality of Life Index--GIQLI) and psychological investigation (Minnesota Multiphasic Personality Inventory--MMPI) the patients underwent laparoscopic fundoplication. Three months after operation all of the patients had quality of life assessment again. RESULTS: Patients were divided into two groups depending on the result of MMPI test. Patients with conversion disorder (CD) preoperatively had significantly lower mean overall score in GIQLI (84.3 +/- 16.3) in comparison to patients without CD (93.0 +/- 19.4). The mean score increased significantly in both groups 3 month after surgery (to 100.6 +/- 21.2 in patients with CD and to 106.7 +/- 18.1 in patients without CD). CONCLUSION: Quality of life in GERD patients is significantly impaired. It shows general improvement after surgery. There are findings in the literature and in our research project showing that comorbidities or psychological factors are able to affect the subjective outcome without any fundamental explanations or basis. Thus, psychological intervention can decrease the spectrum of symptoms and improve the subjective outcome of fundoplication in selected patients.