HP17P BARRETT'S OESOPHAGUS AND THE SYMPTOMATIC EFFICACY OF FUNDOPLICATION

Purpose:   To examine the efficacy of fundoplication for patients with uncomplicated gastro-oesophageal reflux disease (GORD) and Barrett's oesophagus (BO) and to compare the outcomes for patients with BO following either Nissen or Toupet fundoplication. Methods:   A prospectively collected database identified 2990 patients who underwent either Nissen or Toupet laparoscopic fundoplication for GORD or BO between 1991 and 2008. Pre- and post-operative outcomes were measured using a simplified DeMeester scoring system. The scores were recorded for up to 5 years by the same research nurse and compared using small sample statistics. Results:   Of the 2990 patients, 390 (13%) had BO and 2600 (87%) had GORD. Preoperatively, the BO group experienced significantly more symptoms of heartburn than did the GORD group (86 vs. 91% p < 0.01). However, both groups responded equally favourably to fundoplication with high patient satisfaction at 5 years (88 vs. 93%, p = NS). There were no statistically significant differences in post-operative medication and re-operations rates between the two groups. Nissen and Toupet procedures were both equally effective for patients with Barrett's disease with respect to heartburn and regurgitation. At five years there was an increased occurrence of dysphagia in the Toupet group (17%) compared with the Nissen group (4%, p = 0.01). This may follow from the Toupet procedure being favoured for patients with documented primary oesophageal motility disorder (Toupet 47% vs. Nissen 30%, p < 0.01). Conclusions:   The symptoms of uncomplicated GORD and BO respond very well to fundoplication. Both the Nissen and Toupet procedures are equally effective in patients with Barrett's oesophagus.