The follow-up and results of laparoscopic antireflux surgery

Gastro-oesophageal reflux disease is a common disease in the Western world. In addition to lifestyle advice, treatment consists of the use of antacids. Some of the patients do not benefit from antacids, do not want to swallow lifelong antacids or suffer from a diaphragmatic hernia. For this group, antireflux surgery is indicated. Laparoscopic antireflux surgery (so by means of a keyhole surgery) consists of a fundoplication. This means that the fundus of the stomach is placed around the gastro-oesophageal junction, where it forms a cuff. The classic fundoplication describes a 360-degree coverage of the fundus, but a partial fundoplication provides equal reflux control with less side effects. In this thesis, the two "best" partial fundoplicaties (180º wide and 270 behind) were compared. Both of these prove to be equally effective in the short term.
For correction of a diaphragmatic hernia a mesh prosthesis was introduced. However, this might lead to serious complications. In our cohort of patients, the use of a mesh does not result in less symptoms, recurrence or reoperations, when compared to correction without mesh. We therefore recommend not to use it routinely. Correction of a diaphragmatic hernia in elderly patients is safe.
Patients suffering from chronic cough induced by gastro-oesophageal reflux may benefit from laparoscopic partial fundoplication. In the past this was not considered as an effective treament, but we were able to select a cohort of patients that benefited from laparoscopic antireflux surgery.
Patient Reported Outcome Measures should be used for follow-up of laparoscopic antireflux surgery, preferably due to online follow-up, using health-related quality of life questionnaires and symptom scores. After all, it is the patient that should determine whether the operation was successful.