Results of laparoscopic fundoplication where atypical symptoms coexist with oesophageal reflux

Background: Laparoscopic Nissen fundoplication (LNF) has been increasingly performed for gastro-oesophageal reflux disease. The outcomes of LNF for pa tients with concurrent symptoms other than heartburn are unclear. The purpo se of the present paper was to review the outcomes of LNF performed by one surgeon over 4 years and compare the outcomes of patients with reflux sympt oms with those of patients having reflux symptoms plus atypical symptoms. Methods: The records of a consecutive series of 90 patients were reviewed. Preoperative symptoms were defined as typical (heartburn and reflux) or aty pical (other symptoms, e.g. cough, atypical chest pain, choking). At the ti me of follow up an independent observer interviewed patients, and collected data on current symptoms and patient satisfaction. A questionnaire of curr ent symptoms and patient satisfaction was completed. A satisfaction score f rom 1 to 10 was given by patients, with 1 being very unsatisfied and 10 bei ng very satisfied. Results: Of the 90 patients, 97% had typical symptoms and 56% had concurren t atypical symptoms. Eighty-three of 90 patients were contacted; typical re flux symptoms improved in 95% of patients whereas atypical symptoms improve d in only 54%. Overall, the mean satisfaction score was 8.7. Patients with atypical symptoms had a lower satisfaction score of 8.0 versus a satisfacti on score of 9.0 for patients with only typical symptoms (P < 0.05). Patient s with a satisfaction score < 8.0 had a higher rate of atypical symptoms (7 5%) than patients with a satisfaction score greater than or equal to 8 (50% ). Conclusion: Laparoscopic Nissen fundoplication controlled typical reflux sy mptoms very well but atypical symptoms were improved in only approximately 50%. A lower satisfaction score was associated with preoperative atypical s ymptoms.