Quality of life after antireflux surgery compared with nonoperative management for severe gastroesophageal reflux disease

Abstract BACKGROUND: Gastroesophageal reflux disease significantly affects a patient's quality of life (QOL). Laparoscopic fundoplication offers an alternative to medical therapy, but few studies have compared outcomes. Our objective was to examine QOL scores in gastroesophageal reflux disease patients treated medically and surgically. STUDY DESIGN: We undertook a retrospective analysis of patients undergoing surgical or medical treatment for gastroesophageal reflux disease over a 1-year period (August 1997 to August 1998). Followup QOL was measured using the Short-Form 36, and heartburn severity was measured using the Health Related Quality of Life scale (a disease-specific instrument with a best score of 0 and a worst score of 45). RESULTS: Laparoscopic fundoplication was undertaken in 120 patients with a median age of 47 years (range 17 to 80 years). The medical cohort included 51 patients selected from the gastroenterology clinic with a median age of 48 years (range 17 to 82 years). Duration of heartburn was not significantly different, with 40 (78.4%) of the 51 medical and 98 (81.7%) of the 120 surgical patients having had symptoms for longer than 12 months. There were no operative deaths. There were 12 complications (esophageal perforation 1, pneumothorax 2, pneumonia 1, pulmonary embolus 3, other/miscellaneous 5). Mean length of stay was 1.6 days, time to oral intake 1.2 days, and return to normal activity 4.2 weeks. Routine followup was available in 118 surgical and 47 medical patients. The medical cohort had increased (p CONCLUSIONS: Heartburn scores and global QOL scores were superior after laparoscopic fundoplication compared with medical management in this patient population. Laparoscopic fundoplication should be considered for patients who are dissatisfied with medical treatment.