Comparison of symptomatic and quality of life outcomes of laparoscopic versus open antireflux surgery

Background. Even though laparoscopic antireflux procedures have become the surgical treatment of choice for gastroesophageal reflux disease (GERD) lit tle quantitative data exist comparing symptomatic and qualify of life outco mes between laparoscopic and standard open procedures. This study was done to compare short-term outcomes. Methods. All patients referred for surgical treatment of GERD are prospecti vely followed with a disease specific reflux symptom score (the GERD-HRQL, best score 0, worst score 50) and a generic quality of life questionnaire ( the SF-36, best score 100, worst score 0). Patients are evaluated preoperat ively and at least 6 weeks postoperatively, Patients were treated with eith er laparoscopic or open Nissen (360-degree wrap) or Toupet (270-degree wrap ) fundoplications. Results. Sixty patients underwent laparoscopic surgery (LS) and 20 open sur gery (OS). LS and OS had significant improvement in the median GERD-HRQL sc ores, 27 to 3 and 27 to 1, respectively, both P < .000001. LS had statistic ally significant improvements in the SF-36 domains of mental health (62 to 71.5, P = .05) and general health (57 to 67, P = .004). There was no worsen ing in any of the other 6 domains. OS produced a worsening score in the dom ain of physical functioning (75 to 67.5, P = .02). LS had better postoperat ive scores compared with OS in the domains of physical functioning (80 vs 6 7.5, P = .05) and trended to better scores in bodily pain (64 vs 51.5, P = .09). Conclusions. LS produces equivalent improvement in reflex symptoms compared with OS, with improved general quality of life outcomes.