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Uribarri-Gonzalez L, Nieto-Garcia L, Martis-Sueiro A, Dominguez-Muñoz JE. Impact of gastrointestinal symptoms and psychological disturbances on patients' quality of life after restrictive or malabsorptive bariatric surgery. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:92-101. [PMID: 35292333 DOI: 10.1016/j.gastrohep.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to evaluate and compare the presence and impact of Gastrointestinal (GI) symptoms, physical and psychological disturbances on patients' QoL after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS). METHODS A prospective, observational, cross-sectional, comparative study was carried-out. GI symptoms and patients' QoL were evaluated by the SF-36 questionnaire and the GI quality of life index (GIQLI). Correlation between GI symptoms, psychological disturbances and QoL scores was analysed. RESULTS 95 patients were included (mean age 50.5 years, range 22-70; 76 females). Presence of GI symptoms was a consistent finding in all patients, and postprandial fullness, abdominal distention and flatulence had a negative impact on patients' QoL. Patients after SG showed a worsening of their initial psychological condition and the lowest QoL scores. Patients after RYGB showed the best GI symptoms-related QoL. CONCLUSIONS Both restrictive and malabsorptive bariatric surgical procedures are associated with GI symptoms negatively affecting patients' QoL. Compared to SG and BPD/DS, patients after RYGB showed the best GI symptoms-related QoL, which can be used as additional information to help in the clinical decision making of the bariatric procedure to be performed.
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Affiliation(s)
| | | | | | - J Enrique Dominguez-Muñoz
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Spain
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Fuchs KH, Musial F, Eypasch E, Meining A. Gastrointestinal Quality of Life in Gastroesophageal Reflux Disease: A Systematic Review. Digestion 2022; 103:253-260. [PMID: 35605592 DOI: 10.1159/000524766] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Gastrointestinal Quality of Life Index (GIQLI) is a well-established instrument for the assessment of quality of life (QOL) in gastrointestinal (GI) diseases. The purpose of this literature review was to investigate QOL by means of GIQLI in patients with gastroesophageal reflux disease (GERD) prior to any interventional therapy. There are several reports on GIQLI data; however, comparisons from different countries and/or different GERD cohorts assessing the same disease have to date not been conducted. METHODS The GIQLI uses 36 items around 5 dimensions (GI symptoms [19 items], emotional dimension [5 items], physical dimension [7 items], social dimension [4 items], and therapeutic influences [1 item]). A literature search was conducted on the application of GIQLI in GERD patients prior to interventional therapy using reports in PubMed. Data on the mean GIQLI as well as index data for the 5 dimensions as originally validated were extracted from the published patient cohorts. A comparison with the normal healthy control group from the original publication of the GIQLI validation conducted by Eypasch was performed. Data are presented descriptively as GIQLI points as well as a reduction from 100% maximum possible index points (max 144 index points = highest QOL). RESULTS In total, 77 abstracts from studies using the GIQLI on patients with GERD were identified. After screening for content, 21 publications were considered for further analysis. Ten studies in GERD patients comprised complete calculations of all dimensions and were included in the analysis. Data from 1,682 study patients were evaluated with sample sizes ranging from 33 to 568 patients (median age of 789 females and 858 males: 51.8 years). The median overall GIQLI for the patient group was 91.7 (range 86-102.4), corresponding to 63.68% of the maximum GIQLI. The dimensions with the largest deviation from the respective maximum score were the physical dimension (55% of maximum) followed by the emotional dimension (60% of maximum). In summary, the GIQLI level in GERD cohorts was reduced to 55-75% of the maximum possible index. CONCLUSIONS Severe GERD causes substantial reductions in the patient's QOL. The level of GIQLI can carry between different studied GERD cohorts from different departments and countries. GIQLI can be used as an established tool to assess the patient's condition in various dimensions.
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Affiliation(s)
- Karl-Hermann Fuchs
- Laboratory for Interventional and Experimental Endoscopy InExEn, Gastroenterology, University of Würzburg, Würzburg, Germany
| | - Frauke Musial
- Department of Community Medicine, National Research Center in Complementary and Alternative Medicine, NAFKAM, UiT, The Arctic University of Norway, Tromsø, Norway
| | | | - Alexander Meining
- Laboratory for Interventional and Experimental Endoscopy InExEn, Gastroenterology, University of Würzburg, Würzburg, Germany
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Singla V, Kumar A, Gupta M, Manohar M, Monga S, Agarwal S, Sharma AK, Aggarwal S. Gastrointestinal Quality of Life in Morbidly Obese Patients Undergoing One Anastomosis Gastric Bypass (OAGB): Derivation of a "Mini GIQLI" Score. Obes Surg 2022; 32:2332-2340. [PMID: 35488108 DOI: 10.1007/s11695-022-06080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is now one of the mainstream bariatric surgical procedures with proven safety and efficacy. However, data on the gastrointestinal quality of life following OAGB is lacking. METHODS This is a retrospective analysis of a prospectively collected database, performed at a single tertiary care teaching hospital from January 2016 until March 2021. All patients undertook the Gastrointestinal Quality of Life Index (GIQLI) questionnaire. GIQLI was correlated with various parameters. Principal component analysis (PCA) was used to assess the importance of each question in the questionnaire and devise a "Mini GIQLI score". RESULTS A total of 60 patients were included. The %TWL at 3 and 5 years was 26.2 ± 11.9%, 31.7 ± 11 respectively. The mean weight regain was 5.6 ± 8.5 kg. The mean GIQLI score was 125 ± 13.1. The mean scores for questions pertaining to gastrointestinal, social, psychological, and physical domains were 3.49, 3.7, 3.45, and 3.27 respectively. Scree plot of principal component analysis showed that a new score ("Mini GIQLI") combining only 5 questions had good correlation with the overall GIQOL score (r = 0.842). The five questions related to anxiety, fatigue, feeling unwell, loss of endurance, and feeling unfit. CONCLUSIONS Patients report a good score on GIQLI assessment following OAGB. The Mini GIQLI score is a quicker tool with good correlation to the full-length GIQLI score.
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Affiliation(s)
- Vitish Singla
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Amardeep Kumar
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Mehul Gupta
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Manav Manohar
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Sukhda Monga
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Kumar Sharma
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India.
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Singh A, Ford AM, McMichael J, Gabbard S. Role of Neuromodulators for the Management of Post-Gastric-Fundoplication Dyspepsia: A Retrospective Series. Cureus 2021; 13:e18343. [PMID: 34725600 PMCID: PMC8555753 DOI: 10.7759/cureus.18343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 11/05/2022] Open
Abstract
Post-fundoplication dyspepsia is a common complication of gastric fundoplication surgeries. This can be attributable to the loss of fundal relaxation, decreased gastric accommodation, and/or alterations in gastric motility and sensitivity following fundoplication. The role of neuromodulators in the management of such symptoms is unknown. We retrospectively assessed the efficacy of neuromodulators such as tricyclic antidepressants, buspirone, and mirtazapine for the management of post-fundoplication dyspepsia.
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Affiliation(s)
- Achintya Singh
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Andrew M Ford
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - John McMichael
- General Surgery, Cleveland Clinic Foundation, Cleveland, USA
| | - Scott Gabbard
- Gastroenterology, Cleveland Clinic Foundation, Cleveland, USA
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Jacobs JW. Symptom Overview and Quality of Life. THE ESOPHAGUS 2021:1-17. [DOI: 10.1002/9781119599692.ch1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Stellato RK, Mulder FVM, Tytgat SHA, Oudman TS, van der Zee DC, van de Peppel-Mauritz FA, Lindeboom MYA. Two-Year Outcome after Laparoscopic Fundoplication in Pediatric Patients with Gastroesophageal Reflux Disease. J Laparoendosc Adv Surg Tech A 2020; 30:834-840. [PMID: 32423278 DOI: 10.1089/lap.2020.0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Many studies on short-term efficacy of laparoscopic antireflux surgery (LARS) have shown good to excellent results on reflux symptom control and health-related quality of life (HRQoL). Prospective studies on the long-term efficacy, however, are scarce and indicate that the efficacy of symptom control may decline over time. The aim of this study is to assess the 2-year outcome on reflux symptoms and HRQoL after LARS. Materials and Methods: Between 2011 and 2013, 25 children (12 males, median age 6 [2-18] years) with proton pump inhibitor-resistant gastroesophageal reflux disease were included in a prospective longitudinal cohort study. To assess reflux symptoms and HRQoL, patients and/or their caregivers were asked to fill out the validated age-appropriate gastroesophageal reflux symptom questionnaire and Pediatric Quality of Life Inventory™ before, 3 months, 1 year, and 2 years after LARS. Results: Two years after LARS, 29% of patients had moderate to severe reflux symptoms compared with 92% (P < .001) before operation and 12% 3-4 months after operation (P = .219). The significant increase in HRQoL shortly after fundoplication (80.0 compared with 69.5 (P = .004)) is not observed after 2 years (72.0 compared with 69.5, P = .312). Correlation between the impaired HRQoL scores and the recurrence of symptoms could not be verified. Conclusions: Although the efficacy of LARS tends to deteriorate after 2 years, LARS is still effective in controlling reflux symptoms in the majority of patients. The short-term improvement in HRQoL after LARS appears to be transient.
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Affiliation(s)
- Rebecca K Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Femke V M Mulder
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Stefaan H A Tytgat
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tycho S Oudman
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Femke A van de Peppel-Mauritz
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maud Y A Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Mauritz FA, Stellato RK, van Heurn LWE, Siersema PD, Sloots CEJ, Houwen RHJ, van der Zee DC, van Herwaarden-Lindeboom MYA. Laparoscopic antireflux surgery increases health-related quality of life in children with GERD. Surg Endosc 2016; 31:3122-3129. [PMID: 27864715 PMCID: PMC5501913 DOI: 10.1007/s00464-016-5336-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/02/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Improving health-related quality of life (HRQoL) is increasingly recognized as an essential part of patient care outcome. Little is known about the effect of laparoscopic antireflux surgery (LARS) on the HRQoL in the pediatric patients. The aims of this study were to evaluate the effect of LARS on HRQoL in children with gastroesophageal reflux disease (GERD) and to identify predictors that influence HRQoL outcome after LARS. METHODS Between 2011 and 2013, 25 patients with therapy-resistant GERD [median age 6 (2-18) years] were included prospectively. Caregivers and children with normal neurodevelopment (>4 years) were asked to fill out the validated PedsQL 4.0 Generic Core Scales before and 3-4 months after LARS. RESULTS The PedsQL was completed by all caregivers (n = 25) and 12 children. HRQoL total score improved significantly after LARS, both from a parental (p = 0.009) and child's perspective (p = 0.018). The psychosocial health summary and physical health summary scores also improved significantly after LARS. HRQoL before and after LARS was significantly lower in children with impaired neurodevelopment (p < 0.001). However, neurodevelopment did not influence the effect of LARS on HRQoL. The only significant predictor for improvement in HRQoL after LARS was age at the time of operation (p = 0.001). CONCLUSIONS HRQoL significantly improves after LARS. Although children with impaired neurodevelopment had lower overall HRQoL, neurodevelopment by itself does not predict inferior improvement in HRQoL after LARS. Older children have a more favorable HRQoL outcome after LARS compared to younger children. This may suggest caution when considering LARS in younger GERD patients.
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Affiliation(s)
- Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands. .,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Rebecca K Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W Ernst van Heurn
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelius E J Sloots
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
| | - Roderick H J Houwen
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Maud Y A van Herwaarden-Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
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Gastro-intestinal Quality of Life After Metabolic Surgery for the Treatment of Type 2 Diabetes Mellitus. Obes Surg 2016; 25:1371-9. [PMID: 25771793 DOI: 10.1007/s11695-014-1520-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Emerging evidence has shown that bariatric/metabolic surgery ameliorates type 2 diabetes (T2DM) in mildly obese patients (BMI < 35 kg/m(2)) but long-term data is inadequate. We investigated the change of the quality of life after metabolic surgery in not well-controlled T2DM patients with BMI < 35 kg/m(2). METHODS The quality of life was measured by the gastrointestinal quality of life index (GIQLI), a 36-item questionnaire divided into three domains of general health and one domain of specific gastro-intestinal symptoms, administered before operation, at 3, 6, and 12 months after surgery. A control group matched in age, gender, and BMI was recruited for comparison. RESULTS A total of 86 patients were enrolled, and the preoperative BMI and HbA1C (mean ± SD) were 30.7 ± 2.8 kg/m(2) and 9.3 ± 2.1 %, respectively. At 1 year after surgery, the BMI and HbA1C were 24.3 ± 2.3 kg/m(2) and 6.2 ± 1.1 %, respectively. There was a significantly improvement in all of the measures of glucose metabolism. Complete remission (HbA1C < 6.0 %) was achieved in 56 subjects (65 %) at 12 months. The GIQLI score was significantly impaired in T2DM patients before surgery compared with the control group. The GIQLI score significantly increased from 109.2 ± 20.0 to 116.1 ± 14.2 points 1 year after surgery. The patients had improvement in the three domains of general health (social, physical, and emotional function) without a difference with the normal control but deteriorated in the domain of specific symptoms. Most of the patients experienced symptoms including abdominal pain, bloating, flatulence, belching, abdominal noise, regurgitation, dysphagia, slow eating speed, nausea, bowel urgency, and incontinence after metabolic syndrome. CONCLUSIONS Health-related QOL improved dramatically after metabolic surgery for not well-controlled T2DM patients with BMI < 35 kg/m(2), but patients might develop specific gastro-intestinal symptoms after surgery.
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Bariatric versus diabetes surgery after five years of follow up. Asian J Surg 2015; 39:96-102. [PMID: 26235458 DOI: 10.1016/j.asjsur.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 04/16/2015] [Accepted: 04/28/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Bariatric surgery (BS) is totally different from diabetes surgery (DS) in the patient characters, goals of surgery, and management although similar in surgical procedure. Comparison of BS and DS with long-term data is lacking. MATERIALS AND METHODS A retrospective review of patients who received BS and patients who received DS at Min-Sheng General Hospital from 2007 to 2013 was designed. All inpatient and outpatient follow-up data were analyzed. Patients undergoing BS for the treatment of morbid obesity were compared with patients undergoing metabolic surgery for the treatment of type 2 diabetes mellitus (T2DM). Patients who received revision surgeries were excluded. The main outcome measures were: (1) operation risk; (2) weight loss; and (3) diabetes remission. RESULTS Between 2007 and 2013, 2073 patients who received BS and 741 patients who received DS were recruited from both centers. DS patients were older (41.1 ± 10.9 years vs. 33.1 ± 9.3 years, p < 0.05) and were more likely to be male (40.2% vs. 28.2%, p < 0.05) and to have diabetes (100% vs. 6.0%, p < 0.05), however, they had similar body mass index (BMI) (37.9 ± 8.0 vs. 38.5 ± 9.7, p = 0.78) compared to the BS patients. Surgical procedures are significantly different between the two groups (73.3% of the DS surgeries were gastric bypass procedure, whereas this procedure made up only 47.1% of BS surgeries). Although the major complication rates were similar (2.0% vs. 2.4%), the DS program had a significant higher mortality rate than the BS program (0.54% vs. 0.1%; p < 0.05). At the 5-year follow-up time point, 58.0% of the BS patients had achieved successful results (weight loss > 30%) and 80% of the DS patients had complete remission of their diabetes [hemoglobin A1c (HbA1c) < 6.0%]. Both the DS and the BS group had good results in up to 85% of the patients at the 5-year follow-up time point. CONCLUSION The clinical profiles were very different between the BS and the DS programs. Both programs achieved the desired outcomes equally well, however, the DS program had a higher risk than the BS program.
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Medium-Term Results of Laparoscopic Sleeve Gastrectomy: a Matched Comparison with Gastric Bypass. Obes Surg 2015; 25:1431-8. [PMID: 25648253 DOI: 10.1007/s11695-015-1582-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Yu PJ, Tsou JJ, Lee WJ, Lee KT, Lee YC. Impairment of gastrointestinal quality of life in severely obese patients. World J Gastroenterol 2014; 20:7027-7033. [PMID: 24944498 PMCID: PMC4051947 DOI: 10.3748/wjg.v20.i22.7027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/07/2014] [Accepted: 03/06/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the common gastro-intestinal symptoms and quality of life in severely obese subjects.
METHODS: We prospectively recruited 340 severely obese patients [mean age 30.5 ± 7.8 years; mean body mass index (BMI) 42.9 ± 6.1 kg/m2] and 340 healthy persons (mean BMI 23.1 ± 3.8 kg/m2) matched in sex, age, marriage and education. The quality of life was studied using a specific gastrointestinal quality of life index (GIQLI) questionnaire. The 36 items and four functional domains of the GIQLI were compared and analyzed between the groups. The possible correlation of GIQLI scores with specific clinical variables in severely obese patients was assessed by measuring Pearson’s coefficient of correlation.
RESULTS: The mean GIQLI score of severely obese patients was lower than the normal control group (108.5 ± 17.1 vs 123.2 ± 14.8, P < 0.01). Severely obese patients had decreased scores in the domains of general health, including physical (17.3 ± 6.0 vs 22.4 ± 3.1, P < 0.01), emotional (12.6 ± 4.3 vs 16.6 ± 3.1, P < 0.01) and social function (14.7 ± 3.9 vs 17.9 ± 2.5, P < 0.01), and in the domain of gastrointestinal symptoms (63.9 ± 6.7 vs 66.3 ± 7.2, P < 0.05). A significantly decreased score was found in nine items, and there was an increased score in one out of the 19 items in the domain of symptoms of the GIQLI questionnaire. The decreased score in the domain of symptoms was correlated with increasing glycosylated hemoglobin (HbA1c) levels.
CONCLUSION: Severe obesity resulted in a significant impairment of the quality of life and caused specific gastrointestinal symptoms compared with normal controls. The development of gastrointestinal symptoms is correlated increasing HbA1c, suggesting that a poor control of hyperglycemia might be the etiology.
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A randomized trial on endoscopic full-thickness gastroplication versus laparoscopic antireflux surgery in GERD patients without hiatal hernias. Surg Laparosc Endosc Percutan Tech 2013; 23:212-22. [PMID: 23579521 DOI: 10.1097/sle.0b013e3182827f79] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND GOALS Endoscopic full-thickness gastroplication by the Plicator instrument has proven to be a safe and effective method to improve symptoms of gastroesophageal reflux disease. This is the first comparative objective data study for endoscopic versus laparoscopic antireflux procedures. STUDY In this single-center controlled open trial in 70 adult patients with documented gastroesophageal reflux disease without hiatal hernias, objective and subjective outcome parameters were evaluated prospectively and compared. Patients were randomly assigned to either endoscopic full-thickness gastroplication or laparoscopic antireflux surgery. Patients in the Plicator group received between 1 and 3 transmural-pledgeted sutures to the gastric cardia. Patients in the laparoscopic anti-reflux surgery (LARS) group underwent Nissen or Toupet fundoplication. Esophageal manometry, 24-hour impedance pH monitoring, Gastrointestinal Quality-of-Life Index, and symptom questionnaires were evaluated at baseline and at the 3-month follow-up for significant (P<0.05) changes and differences. RESULTS Lower esophageal sphincter pressures were increased in the LARS group and unchanged in the Plicator group. Total reflux numbers, acid, nonacid, proximal, upright, and recumbent reflux events were reduced in both groups, significantly more in the LARS group. Reductions in reflux-related esophageal acid scores were significant only in the LARS group. Similar improvements of Gastrointestinal Quality-of-Life Index were found in both groups. General and gas-related symptom scores were comparably reduced. Greater Reductions in reflux-specific symptom scores were found after LARS. Bowel dysfunction symptom scores were lower after LARS. CONCLUSIONS Improvements in the general subjective outcome parameters were similar after endoscopic full-thickness gastroplication compared with LARS despite a stronger reflux control provided by LARS. More effective relief of reflux-related symptoms favors LARS, and differences in side effect symptoms favor endoscopic full-thickness gastroplication.
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Full-thickness gastroplication for the treatment of gastroesophageal reflux disease: short-term results of a feasibility clinical trial. Surg Laparosc Endosc Percutan Tech 2013; 22:503-8. [PMID: 23238376 DOI: 10.1097/sle.0b013e318265af1f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This was a prospective study that evaluates subjective and objective patient parameters 3 months after full-thickness gastroplication. Forty-one patients with documented gastroesophageal reflux disease and persistent symptoms despite medical treatment, without radiologic visible hiatal hernia, were enrolled in the study and underwent endoscopic full-thickness gastroplication with one or more plicator implants. Evaluation of Gastrointestinal Quality of Life Index, symptoms typically related to reflux, gas bloat, and bowel dysfunction and esophageal manometry, and impedance-pH monitoring were performed at baseline and 3 months after the procedure. The mean Gastrointestinal Quality of Life Index score, and general and reflux-specific scores improved significantly (P<0.01), and gas bloat-specific symptom scores and bowel dysfunction-specific symptom scores were reduced (P<0.05) on follow-up. The numbers of total, acid, proximal, upright, and recumbent reflux episodes were all reduced (P<0.01). Manometric data remained almost unchanged. DeMeester score reduced nonsignificantly (P<0.098). 21.6% of the patients were on proton-pump inhibitor medication on a daily basis after the procedure. There was only 1 postprocedure incident (bleeding) that required intervention. In conclusion, endoscopic full-thickness plication is a safe and well-tolerated procedure that significantly improves quality of life and eliminates gastroesophageal reflux disease symptoms in the majority of patients, without side effects seen after laparoscopic fundoplication.
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Abstract
Gastroesophageal reflux (GER) affects ∼10-20% of American adults. Although symptoms are equally common in men and women, we hypothesized that sex influences diagnostic and therapeutic approaches in patients with GER. PubMed database between 1997 and October 2011 was searched for English language studies describing symptoms, consultative visits, endoscopic findings, use and results of ambulatory pH study, and surgical therapy for GER. Using data from Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, we determined the sex distribution for admissions and reflux surgery between 1997 and 2008. Studies on symptoms or consultative visits did not show sex-specific differences. Even though women are less likely to have esophagitis or Barrett's esophagus, endoscopic studies enrolled as many women as men, and women were more likely to undergo ambulatory pH studies with a female predominance in studies from the US. Surgical GER treatment is more commonly performed in men. However, studies from the US showed an equal sex distribution, with Nationwide Inpatient Sample data demonstrating an increase in women who accounted for 63% of the annual fundoplications in 2008. Despite less common or severe mucosal disease, women are more likely to undergo invasive diagnostic testing. In the US, women are also more likely to undergo antireflux surgery. These results suggest that healthcare-seeking behavior and socioeconomic factors rather than the biology of disease influence the clinical approaches to reflux disease.
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Wong MTC, Abet E, Rigaud J, Frampas E, Lehur PA, Meurette G. Minimally invasive ventral mesh rectopexy for complex rectocoele: impact on anorectal and sexual function. Colorectal Dis 2011; 13:e320-6. [PMID: 21689355 DOI: 10.1111/j.1463-1318.2011.02688.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM Minimally invasive surgery for pelvic floor prolapse has recently been shown to be feasible and safe. This study presents the results of robotic-assisted and laparoscopic rectopexy for complex rectocoele, focusing on less frequently reported outcomes of bowel and sexual function. METHOD We prospectively assessed 41 consecutive patients who underwent ventral mesh rectopexy (robotic-assisted or laparoscopic) for a symptomatic complex rectocoele from January 2009 to January 2010. Complex rectocoele was defined as having one or more of the following features: larger than 3 cm, an enterocoele or internal rectal prolapse. Patients with cystocoele underwent bladder suspension concurrently. Both groups were assessed for anatomical recurrence and function, comparing preoperative and postoperative faecal incontinence, obstructive defaecation syndrome and Gastrointestinal Quality-of-life Index scores, as well as vaginal discomfort and sexual function. RESULTS Forty-one women underwent the procedure (16 robotic-assisted), with four (10.5%) having minor complications and two developing anatomical recurrence. There was significant relief of the commonest predominant symptoms of vaginal bulge/fullness (P<0.0001) and sexual dysfunction (P=0.02). There were three conversions to laparotomy (one robotic-assisted) and five patients declined postoperative functional assessment. In the remaining 33 patients [follow-up median 12 (8-21) months], analysis revealed no significant difference in overall functional score (P>0.740) or between patients with one or two meshes inserted (P>0.486). Only patients with a preoperative obstructive defaecation syndrome score >6 had a significant improvement postoperatively (P=0.030). CONCLUSION Minimally invasive ventral mesh rectopexy for complex rectocoele offers satisfactory anatomical correction and functional results, with the potential for alleviating symptoms of outlet obstruction and improving vaginal comfort and sexual dysfunction.
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Affiliation(s)
- M T C Wong
- Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes - Hotel Dieu, France
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16
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Preoperative symptoms of irritable bowel syndrome predict poor outcome after laparoscopic cholecystectomy. Surg Endosc 2011; 25:3379-84. [PMID: 21556991 DOI: 10.1007/s00464-011-1729-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 03/21/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the accepted treatment for symptomatic cholelithiasis. This study examines the effect LC has on quality of life (QOL) and gastrointestinal (GI) symptoms and determines whether patients with symptoms of irritable bowel syndrome (IBS) gain the same benefit as those without. METHODS A total of 158 patients who underwent LC for symptomatic gallstones were recruited to this prospective observational study. IBS Manning scores were calculated and QOL was measured using the Gastrointestinal Quality of Life Index (GIQLI) preoperatively, at 6 weeks, 3 months, and 2 years postoperatively. Linear regression analysis was used to identify preoperative symptoms that predict outcome. RESULTS One hundred twelve patients had sufficient data sets for inclusion. Patient's GIQLI scores were calculated for the four time points in the study. The mean preoperative score was 88.8 ± 1.3 (61.7% of 144, the highest score possible) and improved 6 weeks after surgery to 105.5 ± 1.3 (p < 0.001). This improvement was maintained at 3 months, but at 2 years analysis showed regression toward the baseline of 7.6 ± 2.3 (p = 0.003) points. There was a negative correlation of -5.2 ± 1.29 (p < 0.001) points between each Manning symptom and QOL scores. The largest effect was seen in patients describing loose bowel movement with the onset of pain. Patients with this symptom had a -17.3 ± 4.6 (p < 0.001) lower global QOL score. CONCLUSIONS Patients with symptoms of IBS indicated by the Manning criteria show less improvement in quality of life after laparoscopic cholecystectomy for gallstones.
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Barnes WE, Hoddinott KM, Mundy S, Williams M. Transoral incisionless fundoplication offers high patient satisfaction and relief of therapy-resistant typical and atypical symptoms of GERD in community practice. Surg Innov 2011; 18:119-29. [PMID: 21307014 DOI: 10.1177/1553350610392067] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This retrospective study evaluated clinical outcomes in 124 consecutive gastroesophageal reflux disease (GERD) patients who underwent transoral incisionless fundoplication (TIF) at 2 community hospitals. Out of 123 patients treated successfully, 110 gave consent (74% female, median age 60 [range 21-87] years, body mass index 27.5 [19.0-47.9]). At a median 7-month follow-up (range 5-17), typical and atypical symptom scores were normalized in 75% to 80% of patients, proton pump inhibitors (PPIs) were completely discontinued by 93%, and 83% were satisfied with their current health condition. Endoscopy in 53 patients revealed Hill grade I tight valves in 89% of the cases, reduced hiatal hernia in 33/34 (97%), and healed reflux esophagitis in 25/30 (83%). Based on global analysis, 72% of the patients were in remission, 20% improved symptomatically, and only 8% had ongoing GERD. These results supported the safety and efficacy of TIF as well as encouraged its application as an alternative treatment of GERD refractory to PPIs.
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Affiliation(s)
- William E Barnes
- Livingston Hospital and Healthcare Services, Inc, Salem, KY, USA.
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Borie F, Glaise A, Pianta E, Veyrac M, Millat B. Long-term quality-of-life assessment of gastrointestinal symptoms before and after laparoscopic Nissen fundoplication. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2010; 34:397-402. [PMID: 20570075 DOI: 10.1016/j.gcb.2009.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Revised: 03/30/2009] [Accepted: 10/21/2009] [Indexed: 05/29/2023]
Abstract
PURPOSE This was a prospective quality-of-life (QoL) assessment of gastrointestinal symptoms before laparoscopic Nissen fundoplication and during the 6-year postoperative follow-up. METHODS Over a 15-month period, 35 consecutive patients with gastroesophageal reflux disease (GERD) underwent surgery after failure of medical treatment with proton pump inhibitors. QoL was assessed using the Gastrointestinal Quality of Life Index (GIQLI) preoperatively, and at 3, 6, 12, 24, 48 and 72 months postoperatively. RESULTS The preoperative GIQLI score was lower than the 'normal' score (126 points), as were the scores overall and for each dimension (social integration, physical function, emotions and gastrointestinal symptoms; all P<0.001). Also, although the GIQLI increased significantly (P<0.0001) at 3, 6, 12, 24, 48 and 72 months, it remained below normal (P<0.01). The symptom score also remained below that of the normal population (57 vs 67; P<0.0001), while the percentages of patients with abdominal pain, dysphagia, modified eating habits and belching decreased non-significantly. However, GERD symptoms were significantly reduced (51% vs 4%; P=0.01), although 20% of patients started taking proton pump inhibitors again during the follow-up period. Surgery eliminated 50% of the dysphagia symptoms reported preoperatively and, after 6 years, only 8% of patients still complained of dysphagia. CONCLUSION Patients who undergo surgery after failure of medical treatment for GERD can expect an improved QoL, although they may not be able to achieve normal levels. Preoperative symptoms should be carefully recorded in order to better inform patients of the expected outcome following surgery.
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Affiliation(s)
- F Borie
- Chirurgie digestive B, CHU Carémeau, Nîmes, France.
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19
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Byars JPD, Pursnani K, Mughal M. Quality of Life and Symptomatology Before and After Nissen Fundoplication. Gastroenterology Res 2010; 3:163-166. [PMID: 27942297 PMCID: PMC5139735 DOI: 10.4021/gr216e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2010] [Indexed: 11/21/2022] Open
Abstract
Background Post surgical quality of life (QOL) plays an important role in the decision making process for patients. This study evaluated the subjective opinion of those that underwent Nissen fundoplication to correct their symptoms of hiatus hernia. This study was to evaluate the quality of life and symptomatology before and after in those patients that underwent Nissen fundoplication over an 8-year period. Methods A questionnaire that graded the severity of symptoms and quality of life pre- and post-operatively was sent out to those patients that had undergone Nissen fundoplication. Results After the operation the symptoms of heartburn, regurgitation, burping and difficulty lying down were markedly decreased (P < 0.0001). There was however an increased incidence of flatulence associated with the procedure (P < 0.0001). Despite this the quality of life was significantly increased in those that underwent Nissen fundoplication (P < 0.0001). Conclusions Nissen Fundoplication has a positive impact on quality of life and is effective in reducing symptoms of heartburn, regurgitation, burping and difficulty lying down associated with a hiatus hernia. There is however an increase in the incidence of flatulence associated with the procedure. In spite of this, 94% of patients would recommend the procedure to someone else.
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Affiliation(s)
| | - Kishore Pursnani
- Department of General Surgery, Royal Preston Hospital, Sharoe Green Lane, Preston, UK
| | - Muntzer Mughal
- Department of General Surgery, Royal Preston Hospital, Sharoe Green Lane, Preston, UK
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20
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Engelmann C, Gritsa S, Ure BM. Impact of laparoscopic anterior 270 degrees fundoplication on the quality of life and symptoms profile of neurodevelopmentally delayed versus neurologically unimpaired children and their parents. Surg Endosc 2009; 24:1287-95. [PMID: 20033727 DOI: 10.1007/s00464-009-0762-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 10/14/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND This prospective study investigated the therapy-induced changes in the quality of life (QoL) experienced by neurologically healthy and neurodevelopmentally delayed children and their parents after laparoscopic anterior 270 degrees fundoplication (LAF). METHODS In this study, 40 patients (21 impaired) with a mean age of 7.8 years underwent LAF for gastroesophageal reflux disease (GERD) and were evaluated before surgery and then 3 and 6 months afterward using the Gastrointestinal Quality-of-Life Index (GIQLI) supplemented by conventional symptom markers. RESULTS Growth, proton pump inhibitor use, and frequency of supraesophageal/respiratory symptoms improved significantly (p < 0.001) as did feeding parameters (p < 0.05). The global GIQLI score improved by 49 +/- 21% (p < 0.001). The greatest improvement occurred in the symptoms domain (p < 0.001). However, positive alterations also were found in the dimensions of emotions (58%), social functions (37%) and physical functions (27%) (p < 0.001). Comparison of the overall benefit did not show any differences between the subgroups of neurologically fit and impaired children. However, for the child-centered symptoms domain, the benefit increased stepwise with the degree of impairment. This was counterbalanced by an inverse relationship for the parent-centered emotions domain (p < 0.05). CONCLUSIONS Besides the known improvement in symptoms, LAF achieves a significant improvement in QoL for children and their parents. There is no overall difference in the benefit experienced by neurologically impaired and healthy children.
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Affiliation(s)
- Carsten Engelmann
- Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany.
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21
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Wang W, Huang MT, Wei PL, Lee WJ. Laparoscopic antireflux surgery for the elderly: a surgical and quality-of-life study. Surg Today 2008; 38:305-10. [PMID: 18368318 DOI: 10.1007/s00595-007-3619-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 05/27/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE Laparoscopic antireflux surgery (LARS) has long been introduced as an alternative method for the treatment of gastroesophageal reflux disease (GERD) in young adults. However, the safety of this procedure and the associated improvement in the quality of life for the elderly are rarely discussed. This study compared the results between young and elderly patients who underwent laparoscopic fundoplication for the treatment of GERD. METHODS From January 1999 to January 2006, there were 231 adult patients who underwent LARS for GERD at a single institute. Among all patients, 33 patients were older than 70 years old (14.3%, 73.0 +/- 1.9, range 70-76), 198 patients were younger than 70 years old (85.7%, 46.6 +/- 11.5, range 20-69). The clinical characteristics, operation time, postoperative hospital stay, surgical complications, and quality of life were retrospectively analyzed. RESULTS The mean operation time had no significant difference between the younger group and the elderly group. The mean postoperative hospital stay in the elderly group was slightly longer than the younger group (4.1 +/- 2.5 days vs 3.4 +/- 1.3 days, P = 0.19). There were no mortalities and no major complications found in each group. No patients required conversion to an open procedure. Four patients had minor complications (three in the elderly group, rate: 9.0%; one in the younger group, rate: 0.5%, P < 0.05). There were two patients in the nonelderly group who had recurrence. A comparison of the preoperative and postoperative Gastro-Intestinal Quality of Life Index (GIQLI) scores showed significant improvements (99.3 +/- 19.2 points, and 110.2 +/- 20.6 points, respectively, P < 0.05) with no significant difference between the two groups. CONCLUSION Laparoscopic antireflux surgery thus appears to provide an equivalent degree of safety and symptomatic relief for elderly patients with GERD as that observed in young patients.
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Affiliation(s)
- Weu Wang
- Department of Surgery and Minimal Invasive Center, Taipei Medical University Hospital, Taipei, Taiwan, China
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Rosenthal R, Peterli R, Guenin MO, von Flüe M, Ackermann C. Laparoscopic antireflux surgery: long-term outcomes and quality of life. J Laparoendosc Adv Surg Tech A 2007; 16:557-61. [PMID: 17243869 DOI: 10.1089/lap.2006.16.557] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To evaluate the outcome of antireflux surgery, we assessed disease-specific symptoms and quality of life of all patients treated by laparoscopic fundoplication at our center between 1992 and 2002. MATERIALS AND METHODS Preoperative symptoms and details of surgery were evaluated for 186 laparoscopic fundoplications. Disease-specific symptoms and quality of life were assessed using a questionnaire. Of 186 patients, 143 returned the questionnaire. RESULTS The most common preoperative symptoms under medical antireflux therapy were regurgitation (54%) and heartburn (30%). Indications for surgery were refractory symptoms (88%) and the patient denying long-term medication (42%). The surgical approaches were Nissen fundoplication (98%) or Toupet fundoplication (2%, for heavy esophageal motility disorder). The conversion rate was 10%. There were no deaths, and 6 patients (3%) had to be reoperated. The questionnaire revealed that in 82% of the patients who responded, the preoperative reflux symptoms were gone, and 94% were satisfied with the result and would undergo surgery again. The average gastrointestinal quality of life index was 115 points (healthy volunteers in the literature, 120.8 points). CONCLUSION Laparoscopic fundoplication is a safe antireflux therapy resulting in high levels of patient satisfaction and near-normal quality of life in the long term.
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de Souza Cury M, Ferrari AP, Ciconelli R, Ferraz MB, Moraes-Filho JPP. Evaluation of health-related quality of life in gastroesophageal reflux disease patients before and after treatment with pantoprazole. Dis Esophagus 2006; 19:289-93. [PMID: 16866863 DOI: 10.1111/j.1442-2050.2006.00581.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastrooesophageal reflux disease (GERD) is highly prevalent in the Western world but its true population prevalence is difficult to estimate without a validated instrument to detect it. The evaluation of health-related quality of life (HRQoL) is an useful tool in this assessment. The aims of this study are to translate and validate a GERD specific HRQoL questionnaire and evaluate HRQoL in a Brazilian population before and after GERD treatment. GERD patients with typical symptoms and Los Angeles Classes A to C esophagitis were included in the study. Two HRQoL questionnaires and upper digestive endoscopy were performed before and after 6 weeks treatment with pantoprazole 40 mg/day followed by 80 mg/day for another 8 weeks if healing did not occur. A generic (SF-36) and one disease-specific questionnaire (GERD score) were used. The latter was translated and validated for Brazilian Portuguese. From January 2002 to December 2003, 100 patients were enrolled. Of these, 78 patients were evaluated in a per protocol analysis (35 men, mean age: 40 years). The translated questionnaire (Brazilian GERD Score, BGERDS) demonstrated adequate psychometric properties (validity, responsiveness and reliability). SF-36 and BGERDS domains significantly improved after treatment (P < 0.01 and P < 0.001 respectively). The BGERDS was shown to be valid and reliable. Patients with esophagitis showed an impaired HRQoL that improved or normalized after treatment with pantoprazole.
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Affiliation(s)
- M de Souza Cury
- Federal University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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24
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Díaz de Liaño A, Yárnoz C, Garde C, Flores L, Artajona A, Romeo I, Ortiz H. [Quality of life after laparoscopic fundoplication for gastroesophageal reflux disease]. Cir Esp 2006; 77:31-5. [PMID: 16420880 DOI: 10.1016/s0009-739x(05)70800-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate our results in terms of satisfaction and quality of life in patients who underwent laparoscopic 360 degrees fundoplication for gastroesophageal reflux disease. PATIENTS AND METHOD We performed a cross-sectional study of 49 consecutive patients who underwent laparoscopic 360 degrees fundoplication for gastroesophageal reflux disease. All patients had been operated on more than 6 months previously by the same surgeon. Postoperative morbidity was recorded. Patients were sent the SF-36 and GIQLI quality of life questionnaires and were also asked about their degree of satisfaction with the surgery. RESULTS The mean age was 40.5 years (range, 23-71). There were nine women and 40 men. All patients underwent a floppy 360 degrees fundoplication and crural closure. There were no conversions. The complication rate was 8.2% (one case each of fever of unknown origin, acute urinary retention, self-limiting bleeding and hernia from a port). Forty-three patients completed the questionnaires (87.7%). Satisfaction with surgery was 8.7 points (out of 10), 89.5% would undergo surgery again and 94.6% would recommend it to a relative. The results of the SF-36 questionnaire were similar to population-based reference values except in the domains of physical functioning and bodily pain where statistically significant differences were found. The mean global GIQLI score was 110.8, which was similar to other studies published in the medical literature. CONCLUSIONS Although this is a cross-sectional study, these preliminary results indicate a high degree of satisfaction with laparoscopic fundoplication, which was reflected in the results of the quality of life questionnaires.
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Affiliation(s)
- Alvaro Díaz de Liaño
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Virgen del Camino, Pamplona, Navarra, Spain
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Abstract
OBJECTIVES To describe differences in operating time, pain scores, analgesic consumption, complications, length of hospital stay, and quality of life in laparoscopic cholecystectomy (LC) vs mini-laparotomy cholecystectomy (MLC). PATIENTS AND METHOD Between 1991 and July 1999, we performed a study of 1041 patients with gallstones who underwent LC (group A, n = 421 patients) or MLC (group B, n = 620 patients). Age, sex, ASA score, pain scores (visual analog scale), analgesic and antiemetic consumption, operating time, complications and length of hospital stay were recorded. Nottingham Health Profile questionnaires were completed by a subgroup of 200 patients, and respiratory response was evaluated using a Fokuda spirometer before surgery and at 24 and 48 hours after surgery. Patient satisfaction and quality of life were evaluated. The results were interpreted using the SPSS program and descriptive statistics were performed with p = 0.05. RESULTS The mean age was 48.9 +/- 14.2 years; 80.5% of the patients were women; 87.88% of the patients were ASA I. Elective surgery was performed in 89.78%. The mean operating time was 94 +/- 45 minutes in LC and was 108 +/- 48 minutes in MLC (p < 0.001). LC was associated with lower postoperative pain (0 = 68.88%), lower analgesic-antiemetic requirements (0 = 9.03%) and shorter length of hospital stay. Complications were significantly more frequent in group B (p = 0.05); two patients in group B died within 30 days of surgery (0.32%). CONCLUSIONS LC appears to be associated with lower pain scores and analgesic-antiemetic requirements and shorter recovery times than MLC. The results in terms of quality of life in LC were excellent.
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Affiliation(s)
- Jorge Ramón Lucena
- Escuela Luis Razetti, Facultad de Medicina Universidad Central de Venezuela, Caracas, Venezuela.
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Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, Jehaes C. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 2005; 20:159-65. [PMID: 16333553 DOI: 10.1007/s00464-005-0174-x] [Citation(s) in RCA: 229] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Accepted: 06/29/2005] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several studies have demonstrated laparoscopic antireflux surgery (LAS) for the treatment of gastroesophageal reflux disease (GERD) to be efficient at short- and midterm follow-up evaluations. The aim of this study was to evaluate the results for LAS 10 years after surgery. METHODS The 100 consecutive patients who underwent LAS by a single surgeon in 1993 were entered into a prospective database. Nissen fundoplication was performed for 68 patients, and partial posterior fundoplication (modified Toupet procedure) was performed for 32 patients. Evaluations of the outcome were made 5 and 10 years after surgery. A structured symptom questionnaire and upper gastrointestinal barium series were used at 5 years. The same questionnaire and an added quality-of-life questionnaire (the Gastrointestinal Quality of Life Index [GIQLI]) were used at 10 years. RESULTS Seven patients died of unrelated causes during the 10-year period. Four patients underwent revision surgery: one patient for persistent dysphagia and three patients for recurrent reflux symptoms. Three patients were lost to any follow-up study. At 5 years, 93% of the patients were free of significant reflux symptoms. At 10 years, 89.5% of the patients still were free of significant reflux (93.3% after Nissen, 81.8% after Toupet). Major side effects (flatulence and abdominal distension) were related to "wind" problems. The GIQLI scores at 10 years were significantly better than the preoperative scores of the patients under medical therapy with proton pump inhibitors. CONCLUSIONS Elimination of GERD symptoms improved quality of life and eliminated the need for daily acid suppression in most patients. These results, apparent 5 years after the operation, still were valid at 10 years.
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Affiliation(s)
- B Dallemagne
- Department of Digestive Surgery, CHC-Les Cliniques Saint Joseph, Belgium.
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27
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Ducrotté P, Leblanc-Louvry I. [Sequelae of sub-mesocolic surgery]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2005; 29:839-45. [PMID: 16294154 DOI: 10.1016/s0399-8320(05)86356-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Philippe Ducrotté
- Hépato-Gastroentérologie et Nutrition, Polyclinique, 76031 Rouen Cedex
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Lee WJ, Yu PJ, Wang W, Chen TC, Wei PL, Huang MT. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg 2005; 242:20-8. [PMID: 15973097 PMCID: PMC1357700 DOI: 10.1097/01.sla.0000167762.46568.98] [Citation(s) in RCA: 335] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This prospective, randomized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic mini-gastric bypass (LMGBP) in the treatment of morbid obesity. SUMMARY BACKGROUND DATA LRYGBP has been the gold standard for the treatment of morbid obesity. While LMGBP has been reported to be a simple and effective treatment, data from a randomized trial are lacking. METHODS Eighty patients who met the NIH criteria were recruited and randomized to receive either LRYGBP (n = 40) or LMGBP (n = 40). The minimum postoperative follow-up was 2 years (mean, 31.3 months). Perioperative data were assessed. Late complication, excess weight loss, BMI, quality of life, and comorbidities were determined. Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index (GIQLI). RESULTS There was one conversion (2.5%) in the LRYGBP group. Operation time was shorter in LMGBP group (205 versus 148, P < 0.05). There was no mortality in each group. The operative morbidity rate was higher in the LRYGBP group (20% versus 7.5%, P < 0.05). The late complications rate was the same in the 2 groups (7.5%) with no reoperation. The percentage of excess weight loss was 58.7% and 60.0% at 1 and 2 years, respectively, in the LPYGBP group, and 64.9% and 64.4% in the LMGBP group. The residual excess weight <50% at 2 years postoperatively was achieved in 75% of patients in the LRYGBP group and 95% in the LMGBP group (P < 0.05). A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted. Both gastrointestinal quality of life increased significantly without any significant difference between the groups. CONCLUSION Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.
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Affiliation(s)
- Wei-Jei Lee
- Department of Surgery, En-Chu Kong Hospital and School of Nursing, Taiwan.
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Kamolz T, Granderath FA, Pointner R. Clinical outcome of laparoscopic antireflux surgery for patients with irritable bowel syndrome. Surg Endosc 2005; 18:1824; author reply 1825-7. [PMID: 15809803 DOI: 10.1007/s00464-004-9086-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Triponez F, Dumonceau JM, Azagury D, Volonte F, Slim K, Mermillod B, Huber O, Morel P. Reflux, dysphagia, and gas bloat after laparoscopic fundoplication in patients with incidentally discovered hiatal hernia and in a control group. Surgery 2005; 137:235-42. [PMID: 15674207 DOI: 10.1016/j.surg.2004.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic fundoplication effectively controls reflux symptoms in patients with gastroesophageal reflux disease (GERD). However, symptom relapse and side effects, including dysphagia and gas bloat, may develop after surgery. The aim of the study was to assess these symptoms in patients who underwent laparoscopic fundoplication, as well as in control subjects and patients with hiatal hernia. METHODS A standardized, validated questionnaire on reflux, dysphagia, and gas bloat was filled out by 115 patients with a follow-up of 1 to 7 years after laparoscopic fundoplication, as well as by 105 subjects with an incidentally discovered hiatal hernia and 238 control subjects. RESULTS Patients who underwent fundoplication had better reflux scores than patients with hiatal hernia ( P = .0001) and similar scores to control subjects ( P = .11). They also had significantly more dysphagia and gas bloat than patients with hiatal hernia and controls ( P < .005 for all comparisons). Gas bloat and dysphagia were more severe in hiatal hernia patients than in controls ( P < 0.005). After fundoplication, the 25% of the patients with the shortest follow-up (1.5 +/- 0.2 years) and the 25% patients with the longest follow-up (5.8 +/- 0.6 years) had similar reflux, dysphagia, and gas bloat scores ( P = .43, .82, and .85, respectively). CONCLUSION In patients with severe GERD, laparoscopic fundoplication decreases reflux symptoms to levels found in control subjects. These results appear to be stable over time. However, patients who underwent fundoplication experience more dysphagia and gas bloat than controls and patients with hiatal hernia-symptoms that should be seen as a side effect of the procedure and of GERD itself.
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Affiliation(s)
- Frederic Triponez
- Clinic and Policlinic of Digestive Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland.
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Coffin B, Dapoigny M, Cloarec D, Comet D, Dyard F. Relationship between severity of symptoms and quality of life in 858 patients with irritable bowel syndrome. ACTA ACUST UNITED AC 2004; 28:11-5. [PMID: 15041804 DOI: 10.1016/s0399-8320(04)94834-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Heath-related quality of life (QoL) is decreased in patients with irritable bowel syndrome (IBS) but the relationship between symptom intensity of IBS and QoL remains largely unknown. The aim of this prospective survey was to investigate the relationship between intensity of IBS and changes in QoL. METHODS Eight hundred and fifty-eight patients with IBS, according to Rome II criteria, completed a symptom questionnaire to measure intensity of IBS, and the gastrointestinal quality of life (GIQLI) questionnaire, which is a general QoL measure in patients with gastrointestinal disorders. RESULTS 37.2% of the patients had constipation-predominant type IBS, 37.3% had diarrhea-predominant IBS and 25.4% had alternating diarrhea and constipation type symptoms. IBS was considered to be in remission or mild in 8.3% of patients; 41.3% had moderate IBS and 50.4% had severe IBS. The mean GIQLI score was 88 +/- 20. There was a significant correlation between symptom intensity and changes in QoL. Other significantly related factors were the type of bowel abnormality and gender. CONCLUSION In IBS patients, symptom intensity and type of IBS have a negative impact on health-related QoL.
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Affiliation(s)
- Benoit Coffin
- Service d'Hépato-Gastroentérologie, Hôpital Louis Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes.
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Kamolz T, Pointner R, Velanovich V. The impact of gastroesophageal reflux disease on quality of life. Surg Endosc 2003; 17:1193-9. [PMID: 12799881 DOI: 10.1007/s00464-002-9229-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2002] [Accepted: 02/19/2003] [Indexed: 12/26/2022]
Abstract
BACKGROUND Quality of life as a medical endpoint has become an important measure in clinical research. METHODS In this article, we review the recent literature that has examined the impact of gastroesophageal reflux disease (GERD) and its treatment of quality of life. RESULTS The increasing interest in measuring patients' quality of life as an outcome reflects an increasing awareness that traditional physiological endpoints often do not correlate well with patients' functional status, general well-being, and satisfaction with therapy. It has been shown that GERD has a significant impact on patients' quality of life; therefore, improvement of quality of life is one of the major goals of GERD treatment. This can be achieved by medical as well as surgical treatment. CONCLUSION In addition to the patients' perspective, quality of life is one of the major endpoints in medical research that will help provide more selective treatment regimens for our patients.
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Affiliation(s)
- T Kamolz
- Division of Clinical Psychology, Public Hospital of Zell am See, A-5700 Zell am See, Austria.
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Khaitan L, Bhatt P, Richards W, Houston H, Sharp K, Holzman M. Comparison of patient satisfaction after redo and primary fundoplications. Surg Endosc 2003; 17:1042-5. [PMID: 12658416 DOI: 10.1007/s00464-002-8846-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2002] [Accepted: 11/12/2002] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although much has been written about the results and patient satisfaction with fundoplication for the treatment of gastroesophageal reflux disease, the reports have focused primarily on surgical successes. With the growing number of fundoplications being performed, more patients are requiring reoperation because of recurrent symptoms or side effects. Reports of success rates for reoperation are available, but information regarding patient satisfaction is limited. METHODS All the patients undergoing fundoplication at our institution were sent short-form health surveys (SF-12), Gastroesophageal reflux disease-specific quality-of-life questionnaires (QOLRAD), and queries regarding long-term satisfaction. RESULTS Between November 1992 and July 2000, 221 patients (198 primary and 23 redo) underwent fundoplication. There were 19 open cases (3 primary and 16 redo). In the primary group, 173 patients underwent Nissen, 23 underwent Toupet, and 2 underwent Collis fundoplications. In the redo group, 12 patients underwent Nissen, 9 underwent Toupet, 1 underwent Collis, and l underwent Belsey fundoplications. Follow-up surveys were completed for 130 patients (112 primary and 18 redo) at a mean of 32.6 months (range, 0.8-98 months). In the primary group, 87% of the patients were satisfied with their operation, as compared with 75% in the redo group. There was a trend toward higher SF-12 mental scores (46 +/- 12 vs 40 +/- 14; p = 0.07) and QOLRAD scores (6.2 +/- 1.3 vs 5.2 +/- 2.0; p = 0.07) in the primary fundoplication group. There was a significant difference in the SF-12 physical scores between the groups (32 +/- 13 for the primary group vs 18.5 +/- 11 for the redo group; p = 0.0002). Additionally, 61% of the patients in the redo group were again using antireflux medications, whereas only 24% of the patients in the primary group were using medications again. CONCLUSION Gastroesophageal reflux disease symptom scores and quality-of-life scores for patients undergoing redo fundoplication are lower than the scores of patients having primary fundoplication. Quality of life is similar between primary and redo fundoplication patients in the mental component. However, redo patients do not do as well physically more than 2 years after surgery.
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Affiliation(s)
- L Khaitan
- Department of Surgery, Vanderbilt University Medical Center, D5203 MCN, Nashville, TN 37232-2577, USA
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Granderath FA, Pointner R, Kamolz T. Characterization of long-term outcomes after Toupet fundoplication. J Clin Gastroenterol 2003; 36:182; author reply 182-3. [PMID: 12544206 DOI: 10.1097/00004836-200302000-00019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Granderath FA, Kamolz T, Schweiger UM, Pointner R. Long-term follow-up after laparoscopic refundoplication for failed antireflux surgery: quality of life, symptomatic outcome, and patient satisfaction. J Gastrointest Surg 2002; 6:812-8. [PMID: 12504219 DOI: 10.1016/s1091-255x(02)00089-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Quality of life and patient satisfaction have been shown to be important factors in evaluating outcome of laparoscopic antireflux surgery (LARS). The aim of this study was to evaluate data pertaining to quality of life, patient satisfaction, and changes in symptoms in patients who underwent laparoscopic redo surgery after primary failed open or laparoscopic antireflux surgery 3 to 5 years postoperatively. Between March 1995 and June 1998, a total of 27 patients whose mean age was 57 years (range 35 to 78 years) underwent laparoscopic refundoplication for primary failed open or laparoscopic antireflux surgery. Quality of life was evaluated by means of the Gastrointestinal Quality of Life Index (GIQLI). Additionally, patient satisfaction and symptomatic outcome were evaluated using a standardized questionnaire. Three to 5 years after laparoscopic refundoplication, patients rated their quality of life (GIQLI) in an overall score of 113.4 points. Twenty-five patients (92.6%) rated their satisfaction with the redo procedure as very good and would undergo surgery again, if necessary. These patients were no longer taking any antireflux medication at follow-up. Two patients (7.4%) reported rare episodes of heartburn, which were managed successfully with proton pump inhibitors on demand, and four patients (14.8%) reported some episodes of regurgitation but with no decrease in quality of life. Seven patients (25.9%) suffer from mild-to-moderate dysphagia 5 years postoperatively, and 12 patients (44.4%) report having occasional chest pain but no other symptoms of gastroesophageal reflux disease. Nine of these patients suffer from concomitant cardiopulmonary disease. Laparoscopic refundoplication after primary failed antireflux surgery results in a high degree of patient satisfaction and significant improvement in quality of life with a good symptomatic outcome for a follow-up period of 3 to 5 years after surgery.
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Affiliation(s)
- Frank A Granderath
- Department of General Surgery, Hospital Zell am See, A-5700 Zell am See, Austria.
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Marambaia O, Andrade NA, Varela D, Juncal M. Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a phmanometria de 24 horas de 2 canais. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0034-72992002000400012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introdução: Manifestações laríngeas do refluxo gastro-esofágico são problemas cada vez mais comuns. Estudos revelam alta associação com sensação de "globus", rouquidão crônica e com tosse crônica. Seu diagnóstico e tratamento diferem da clássica doença do refluxo gastro-esofágico. Os achados à endoscopia laríngea de hiperemia e edema de estruturas glóticas, espessamento do espaço interaritenóideo, granulomas, pólipos, edema de Reinke, estenose subglótica sugerem uma investigação diagnóstica completa através da pHmanometria de 24 horas, exame de maior sensibilidade e especificidade. Objetivo: correlacionar achados clínicos e laringoscópicos precoces sugestivos de refluxo gastro-esofágico com resultados da pHmanometria de 24 horas. Avaliar terapia medicamentosa e modificações dietéticas. Forma de estudo: Clínico prospectivo. Material e Método: pacientes adultos com queixas crônicas: tosse seca, "globus", sialorréia, disfonia, pigarro, halitose e engasgos. Foram excluídos pacientes com outras patologias de vias aéreas. Endoscopia laríngea descartava aqueles que apresentassem lesões laríngeas mais avançadas. Encaminhamento à pHmanometria e iniciado tratamento clínico. Resultados: 83,6% apresentaram refluxo patológico. Sintomas mais freqüentes: disfonia (72,5%), pigarro (60,8%), tosse (29,4%), "globus" (23,5%) e sialorréia (19,6%). Associação de sintomas: dois (67,4%); três (41,2%) e quatro (21,5%). 49 pacientes iniciaram tratamento com omeprazol (20 mg) e dieta: 83,7% cursaram com melhora dos sintomas após 6 meses. Em 95,9% dos pacientes tratados houve melhora laringoscópica. Conclusões: Houve uma correlação importante entre história clínica e endoscopia laríngea com achados à pHmanometria de 24 horas. Outros estudos poderão fortalecer a telescopia laríngea para o diagnóstico do refluxo laringofaríngeo e seu acompanhamento. É necessária abordagem multidisciplinar, além de um aumento do grau de suspeição do especialista.
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Affiliation(s)
- O. Marambaia
- Escola de Medicina e Saúde Pública; Santa Casa da Misericórdia da Bahia
| | - N. A. Andrade
- Escola de Medicina e Saúde Pública; Santa Casa da Misericórdia da Bahia
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Kamolz T, Granderath FA, Pointner R. Quality of life 2 years after laparoscopic total fundoplication. Surg Laparosc Endosc Percutan Tech 2002; 12:305; author reply 306. [PMID: 12193833 DOI: 10.1097/00129689-200208000-00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kamolz T, Granderath PA, Bammer T, Pasiut M, Wykypiel H, Herrmann R, Pointner R. Mid- and long-term quality of life assessments after laparoscopic fundoplication and refundoplication: a single unit review of more than 500 antireflux procedures. Dig Liver Dis 2002; 34:470-6. [PMID: 12236479 DOI: 10.1016/s1590-8658(02)80104-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND For the evaluation of surgical interventions, quality of life data are being increasingly used as an efficacy endpoint. AIMS To evaluate impact of laparoscopic fundoplication and laparoscopic refundoplication on quality of life as well as on patient satisfaction with the procedure for at least 5 years after surgical intervention. PATIENTS After more than 500 laparoscopic antireflux procedures, quality of life data have been prospectively reviewed and data compared with healthy individuals, untreated gastro-oesophageal reflux disease patients (n = 150) and successfully treated patients (n = B4) under adequate omeprazole therapy. METHODS Gastrointestinal Quality of Life Index has been used in all patients and evaluated the day before surgery and 5 times after surgery. Moreover, the SF-36 questionnaire has been used up to 2 years after surgical intervention, but only in patients who underwent laparoscopic redo-surgery (n = 49). RESULTS In both surgical groups, mean preoperative Gastrointestinal Quality of Life Index showed a significant (p < 0.01) impairment (before laparoscopic antireflux surgery: 90.4 +/- 10.3 points; before redo-surgery: 84.3 +/- 8.1 points) when compared with healthy individuals (mean: 122.6 +/- 8.5 points) and successfully treated patients with acid-suppressive therapy (mean: 121.4 +/- 9.2 points). After surgery, the mean Gastrointestinal Quality of Life Index increased significantly and remained stable for at least 5 years after laparoscopic antireflux surgery (120.8 +/- 8.6 points) or for at least 2 years after redo-proce-dure (120.9 +/- 7.2 points). Before laparoscopic refundoplication, 6 out of 8 SF-36 scores were significantly p < 0.05) decreased. Redo-surgery influenced these 6 scores significantly (p < 0.05-0.01), resulting in values comparable to those of general population. Patients' satisfaction with surgery was excellent or good in 95%. CONCLUSION Both, laparoscopic fundoplication as well as laparoscopic refundoplication are able to improve patients' quality of life significantly for at least 5 years. Therefore, quality of life data provide useful information to discuss different treatment options with patients.
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Affiliation(s)
- T Kamolz
- Division of Clinical Psychology, Public Hospital of Zell am See, Austria.
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Marambaia O, Andrade NA, Varela D, Juncal M. Refluxo laringofaringeano: estudo prospectivo correlacionando achados laringoscópicos precoces com a pHmanometria de 24 horas de 2 canais. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0034-72992002000100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introdução: Manifestações laríngeas do refluxo gastro-esofágico são problemas cada vez mais comuns. Estudos revelam alta associação com sensação de "globus", rouquidão crônica e com tosse crônica. Seu diagnóstico e tratamento diferem da clássica doença do refluxo gastro-esofágico. Os achados à endoscopia laríngea de hiperemia e edema de estruturas glóticas, espessamento do espaço interaritenóideo, granulomas, pólipos, edema de Reinke, estenose subglótica sugerem uma investigação diagnóstica completa através da pHmanometria de 24 horas, exame de maior sensibilidade e especificidade. Objetivos: correlacionar achados clínicos e laringoscópicos precoces sugestivos de refluxo gastro-esofágico com resultados da pHmanometria de 24 horas. Avaliar terapia medicamentosa e modificações dietéticas. Forma de estudo: clínico prospectivo randomizado. Método: 61 pacientes adultos com queixas crônicas: tosse seca, "globus", sialorréia, disfonia, pigarro, halitose e engasgos. Foram excluídos pacientes com outras patologias de vias aéreas. Endoscopia laríngea descartava aqueles que apresentassem lesões laríngeas mais avançadas. Encaminhamento à pHmanometria e iniciado tratamento clínico. Resultados: 83,6% apresentaram refluxo patológico. Sintomas mais freqüentes: disfonia (72,5%), pigarro (60,8%), tosse (29,4%), "globus" (23,5%) e sialorréia (19,6%). Associação de sintomas: dois (67,4%); três (41,2%) e quatro (21,5%). 49 pacientes iniciaram tratamento com omeprazol (20 mg) e dieta: 83,7% cursaram com melhora dos sintomas após 6 meses. Em 95,9% dos pacientes tratados houve melhora laringoscópica. Conclusões: Houve uma correlação importante entre história clínica e endoscopia laríngea com achados à pHmanometria de 24 horas. Outros estudos poderão fortalecer a telescopia laríngea para o diagnóstico do refluxo laringofaríngeo e seu acompanhamento. É necessária abordagem multidisciplinar, além de um aumento do grau de suspeição do especialista.
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Affiliation(s)
- O. Marambaia
- Escola de Medicina e Saúde Pública; Santa Casa da Misericórdia da Bahia
| | - N. A. Andrade
- Escola de Medicina e Saúde Pública; Santa Casa da Misericórdia da Bahia
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Kamolz T. Analysis of medical compliance in gastro-oesophageal reflux disease patients referred to pre-surgical examination. Dig Liver Dis 2002; 34:183-9. [PMID: 11990390 DOI: 10.1016/s1590-8658(02)80191-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite potential of modern pharmacotherapy to control gastro-oesophageal reflux disease and also to improve patients' quality of life, an efficient long-term management always depends on patients compliance with medication. AIMS To evaluate and analyse potential aspects of compliance or non-compliance with medical and clinical prescriptions in a selected group of gastro-oesophageal reflux disease patients referred to pre-surgical examination because of persistent or recurrent symptoms. PATIENTS A total of 182 gastro-oesophageal reflux disease patients have been divided by patient rating to 3 different subgroups: group 1/TC consisted of patients who subjectively stated to be totally compliant (n=71; 39%); group 2/PC of patients with partial compliance (n=65; 36%), and group 3/NC consisted of patients with non-compliance (n=46; 25%) in relation to the prescriptions of their doctor taking care of their treatment. METHODS All patients have been asked for potential aspects of compliance or non-compliance. The following aspects have been analysed: understandable medical prescription, information about gastro-oesophageal reflux disease, subjective severity of gastro-oesophageal reflux disease-related symptoms, severity of disease, side-effects of medication, general rejection of medication, multi-medication, patient age and sex, quality of life, and a specific construct of personality (health locus of control). RESULTS Significant differences could be calculated between patients' age and gender showing that female and elderly patients are more compliant with medication. Group 1/TC patients suffered from a significantly longer period of symptoms and received medication for a longer period when compared to the other groups. Quality of life was impaired in all patients but patients in group 3/NC had a significantly better quality of life than patients in group 1/TC. The leading aspects for total compliance were: an understandable medical prescription (95%), high severity of perceived symptoms (76%) and of disease (88%). The major factors in group 2/PC patients have been unclear information about gastro-oesophageal reflux disease (41%), mild severity of perceived symptoms (59%), low severity of disease (30%), and a general rejection of medical treatment (21%). General rejection of drug treatment has been the major factor in group 3/NC patients (80%) which can be viewed in relation to patients' personality CONCLUSION Compliance or non-compliance in this selected group of patients depended on several factors such as information, subjective severity of symptoms, severity of disease but, in addition, on patients' personality Therefore, new strategies for compliance with long-term treatment in gastro-oesophageal reflux disease patients should be discussed.
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Affiliation(s)
- T Kamolz
- Division of Clinical Psychology, Public Hospital of Zell am See, Austria.
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41
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Affiliation(s)
- T Kamolz
- Division of Clinical Psychology at the Department of General Surgery, Public Hospital of Zell am See, Austria.
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Kamolz T, Bammer T, Granderath FA, Pointner R. Laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders. Dig Liver Dis 2001; 33:659-64. [PMID: 11785710 DOI: 10.1016/s1590-8658(01)80041-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several psychological factors are known to affect the subjective outcome, such as quality of life, after laparoscopic antireflux surgery. AIM To evaluate: a. outcome of laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders, b. potential effects of laparoscopic antireflux surgery on psychiatric comorbidities. PATIENTS AND METHODS Out of more than 550 patients who underwent laparoscopic antireflux surgery, 21 suffered from additional anxiety disorders. Outcome assessments included traditional data, evaluation of symptoms and side-effects, and quality of life. These data were evaluated before laparoscopic antireflux surgery and 6 weeks, 3 months and 1 year after surgery, RESULTS Post-operative lower oesophageal sphincter pressure and DeMeester score were normal in all patients. Subjective severity of anxiety disorders remained unchanged in 13 patients 1 year after surgery. One patient suffered from severe dysphagia and required single dilatation. In this patient, severity and frequency of panic attacks increased for approximately 6 months after laparoscopic antireflux surgery. In 7 patients, total relief of panic symptoms was reported within 3 months post-operatively. Severity of most gastro-oesophageal reflux disease-related symptoms decreased significantly after laparoscopic antireflux surgery, but severity of some symptoms remained stable in patients with continuing anxiety disorders. In all patients, Gastrointestinal Quality of Life Index increased significantly. This improvement was less marked in patients with continuing anxiety disorders. Patients presenting total relief of panic symptoms showed an outcome comparable to normal data. CONCLUSIONS Data obtained suggest that patients with concomitant anxiety disorders should not generally be excluded from laparoscopic antireflux surgery but should be selected more carefully. In these patients, surgery significantly improves quality of life and eliminates gastro-oesophageal reflux disease-related symptoms. Some patients demonstrated less symptomatic relief. In contrast, laparoscopic antireflux surgery was able to eliminate panic disorders in one third of our patients.
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Affiliation(s)
- T Kamolz
- Department of General Surgery, Public Hospital of Zell am See, Austria.
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Huguier M, Barrier A, Houry S. [Surgical treatment of gastroesophageal reflux disease in adults]. ANNALES DE CHIRURGIE 2001; 126:618-28. [PMID: 11676232 DOI: 10.1016/s0003-3944(01)00583-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
Pathological gastroesophageal reflux is common. The aim of this review was to compare the results of different surgical techniques. Papers were selected on Medline from 1990 to April 2001. A critical analysis was performed, concerning definitions of included patients, surgical techniques, and criteria of evaluation. For comparison, the results of 23 randomized studies were mainly selected. Their heterogeneity has not allowed a meta-analysis. A few techniques had poorer results than others: simple closure of His angle, Hill operation, Belsey Mark IV technique, and Angelchik prosthesis. In most studies, results of partial fundoplication on reflux were as good as those of total Nissen fundoplication and fewer patients had postoperative dysphagia. In a double blind trial, immediate advantages of laparoscopic approach were less important than those observed in non comparative studies. Another trial was interrupted after inclusion of 103 patients because of the higher rate of side-effects in the laparoscopic group. These results may help the surgeon in the choice of a technique. Patients have to be informed of potential adverse effects of the different techniques chosen by their surgeon.
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Affiliation(s)
- M Huguier
- Service de chirurgie générale et digestive, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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