Patient Reported Outcomes Following Laparoscopic Surgery for Benign Upper Gastrointestinal Disease

Patient reported quality of life (QOL) outcomes are important tools for measuring the success of surgical intervention. This is of particular relevance in benign disease when surgery is specifically indicated primarily to treat symptoms and improve QOL. In upper gastrointestinal disease, common conditions such as achalasia, gastro-oeosphageal reflux disease and para-oesophageal hernias can have a significant impact on patient’s quality of life. The aim of this study was to compare QOL scores before and after surgery for these conditions, and to assess patient satisfaction. Patients who underwent laparoscopic paraoesophageal hernia (POH) repair, laparoscopic cardiomyotomy or laparoscopic fundoplication over a 7 year period (2006-2013) by one surgeon were asked to assess their symptoms before and after surgery using the Gastro-oesophageal Reflux Disease-Health Related Quality-Of-Life (GORD-HRQOL) Score and The Royal Adelaide Dysphagia (RAD) Score, and to rate their satisfaction. All procedures were carried out electively, with no 30day mortality, and an absence of any major peri-operative morbidity. Responses were received from 121 patients (68 female and 53 male). This comprised of 34 POH repairs, 39 cardiomyotomies and 48 fundoplications. Median GORD scores improved significantly for all groups; POH 20.5 to 2, (p<0.0001), Fundoplication 24.5 to 6.5 (p<0.0001), and Cardiomyotomy 21 to 10 (p=0.0008). Dysphagia scores improved significantly for Cardiomyotomy, 7.5 to 30 (p<0.0001),and POH, 25 to 40.5 (p=0.044), but not with Fundoplication 45 to 35.25 (p =0.17). 64% of patients were ‘satisfied’ or ‘very satisfied’ with their current condition. 77% were ’satisfied’ or ‘very satisfied’ with the procedure itself. This study has shown that there is a high rate of patient satisfaction following laparoscopic surgery for benign upper GI disease. INTRODUCTION Benign upper gastrointestinal (GI) diseases including achalasia, gastro-oesophageal reflux disease (GORD) and para-oesophageal hernias (POH) result in a number of overlapping symptoms that can significantly impact upon a patient’s quality of life (QOL). Approximately 89% of patients with GORD complain of heartburn. Bloating, flatulence and dysphagia are also commonly reported symptoms2. The prevalence of GORD in Europe is amongst the highest in the world at 23.7%3, and is known to have a significant adverse impact on QOL 4. Achalasia has an annual incidence of 1 in 100,000 and causes symptoms of progressive dysphagia and regurgitation5,6. Hiatal hernias are common7 with most being the sliding type (type 1)8. Para-oesophageal hernias (types 2-4) account for 5% of all hiatal hernias7. These may present with a variety of symptoms, including heartburn, regurgitation, dysphagia, and chest pain. They can also present acutely with gastric volvulus. All of these conditions can now be effectively managed laparoscopically9. Patient reported outcomes are important tools for measuring the success of surgical interventions. This is of particular relevance in benign disease when surgery is specifically indicated primarily to treat symptoms and improve QOL. There are a number of validated tools for assessing QOL in benign upper GI disease10. The GORD-HRQOL developed by Velanovich et al.11 is one such tool that has been used for GORD specifically and has been validated in a number of other studies12,10. The dysphagia score used in this study was first devised by Dakkak et al1 (Table 1) and has subsequently been used in a number of other studies reporting outcomes following laparoscopic fundoplication13,14 and following laparoscopic cardiomyotomy and anterior Dor fundoplication for achalasia6. The aim of this study was to compare QOL scores before and after laparoscopic surgery for achalasia, GORD and POH and to determine overall patient satisfaction scores. Responses were received from 121 of 184 individual patients.