Long-Term Health-Related Quality of Life (HRQoL) After Redo-Fundoplication

Abstract

Background: We aim to shed light on long-term subjective outcomes after re-operations for failed fundoplication.

Methods: 1809 patients were operated on for hiatal hernia and/or gastroesophageal reflux disease (GERD) at the Helsinki University Hospital between 2000 and 2017. 111 (6%) of these had undergone a re-operation for a failed antireflux operation. Overall, HRQoL was assessed in 89 patients at the latest follow-up using the generic 15D© instrument. The results were compared to a sample of the general population, weighted to reflect the age and gender distribution of patients. Disease-specific HRQoL was assessed using the GERD-HRQoL questionnaire. We studied variation in the overall HRQoL with respect to disease-specific HRQoL and known patients' parameters using univariate and multivariable linear regression models.

Results: The median postoperative follow-up period was 9.3 years. All patients were operated on laparoscopically (6% conversion rate), and 87% were satisfied with the re-operation. Postoperative complications were minimal (5%). Twelve patients (11%) underwent a second re-operation. The median GERD-HRQoL score was nine. In multivariable analysis, four variables were independently associated with the 15D score, suggesting a decrease in the 15D score with increasing GERD-HRQoL score, increasing Charlson Comorbidity Index (CCI) and the presence of chronic pain syndrome (CPS) and depression.

Conclusion: Re-do LF is a safe procedure in experienced hands and may offer acceptable long-term alleviation in patients with recurring symptoms after antireflux surgery. Decreased HRQoL in the long run is related to recurring GERD and co-morbidities.

Fig. 1

a) Distribution curve of scores of GERD-HRQoL questionnaire. The questionnaire gains values between 0 and 75. Zero points means no symptoms and 75 sever and disabling symptoms. Median score was 9 (IQR 2, 20). b) Distribution curve of scores of the 15D-HRQoL questionnaire. The score is a composite of all 15 dimensions and gets values between 0 and 1. Higher values reflect better HRQoL. Mean 15D score was 0.85 (SD 0.12)

Fig. 2

The mean 15D profile of the study population compared to that of the age- and gender-standardized general population. The data for the general population came from the National Health 2011 Health Examination Survey representing the Finnish population aged 18 and over [12]. For this analysis, those individuals were selected, who were in the age range of patients in the catchment area of the Helsinki University Hospital (n = 1178). This sample was weighted to reflect the age and gender distribution of patients. Move—mobility; Excret—excretion; UACT—usual activities; Mental—mental function; Disc—discomfort and symptoms; Depr—depression; Distr—distress; Vital—vitality; Sex—sexual activity. *p is significant at < 0.05 level (independent samples T-test)