Patient Reported Outcomes Following Laparoscopic Surgery for Benign Upper Gastrointestinal Disease

Patient reported quality of life (QOL) outcomes are important tools for measuring the success of surgical intervention. This is of particular relevance in benign disease when surgery is specifically indicated primarily to treat symptoms and improve QOL. In upper gastrointestinal disease, common conditions such as achalasia, gastro-oeosphageal reflux disease and para-oesophageal hernias can have a significant impact on patient's quality of life. The aim of this study was to compare QOL scores before and after surgery for these conditions, and to assess patient satisfaction. Patients who underwent laparoscopic paraoesophageal hernia (POH) repair, laparoscopic cardiomyotomy or laparoscopic fundoplication over a 7 year period (2006-2013) by one surgeon were asked to assess their symptoms before and after surgery using the Gastro-oesophageal Reflux Disease-Health Related Quality-Of-Life (GORD-HRQOL) Score and The Royal Adelaide Dysphagia (RAD) Score, and to rate their satisfaction. All procedures were carried out electively, with no 30- day mortality, and an absence of any major peri-operative morbidity. Responses were received from 121 patients (68 female and 53 male). This comprised of 34 POH repairs, 39 cardiomyotomies and 48 fundoplications. Median GORD scores improved significantly for all groups; POH 20.5 to 2, (p<0.0001), Fundoplication 24.5 to 6.5 (p<0.0001), and Cardiomyotomy 21 to 10 (p=0.0008). Dysphagia scores improved significantly for Cardiomyotomy, 7.5 to 30 (p<0.0001), and POH, 25 to 40.5 (p=0.044), but not with Fundoplication 45 to 35.25 (p =0.17). 64% of patients were ‘satisfied’ or ‘very satisfied’ with their current condition. 77% were 'satisfied’ or ‘very satisfied’ with the procedure itself. This study has shown that there is a high rate of patient satisfaction following laparoscopic surgery for benign upper GI disease.