Quality of life following laparoscopic Nissen fundoplication: Assessing short-term and long-term outcomes

AIM: To investigate the quality of life following lapa-roscopic Nissen fundoplication by assessing short-term and long-term outcomes. METHODS: From 1992 to 2005, 249 patients under-went laparoscopic Nissen fundoplication. Short-term outcome data including symptom response, side effects of surgery, endoscopy, and patient's perception of over-all success were collected prospectively. Long-term out-comes were investigated retrospectively in patients witha median follow-up of 10 years by assessment of reflux symptoms, side effects of surgery, durability of antire-flux surgery, need for additional treatment, patient's perception of success, and quality of life. Antireflux sur-gery was considered a failure based on the following criteria: moderate to severe heartburn or regurgitation; moderate to severe dysphagia reported in combination with heartburn or regurgitation; regular proton pump inhibitor medication use; endoscopic evidence of erosive esophagitis Savary-Miller grade 1-4; pathological 24-h pH monitoring; or necessity to undergo an additional surgery. The main outcome measures were short-and long-term cure rates and quality of life, with patient sat-isfaction as a secondary outcome measure. RESULTS: Conversion from laparoscopy to open sur-gery was necessary in 2.4% of patients. Mortality was zero and the 30-d morbidity was 7.6% (95%CI: 4.7%-11.7%). The median postoperative hospital stay was 2 d [interquartile range (IQR) 2-3 d]. Two hundred and forty-seven patients were interviewed for short-term analysis following endoscopy. Gastro-esophageal reflux disease was cured in 98.4% (95%CI: 95.9%-99.6%) of patients three months after surgery. New-onset dysphagia was encountered postoperatively in 13 patients (6.7%); 95% reported that the outcome was better after antireflux surgery than with preopera-tive medical treatment. One hundred and thirty-nine patients with a median follow-up of 10.2 years (IQR 7.2-11.6 years) were available for a long-term evalu-ation. Cumulative long-term cure rates were 87.7% (81.0%-92.2%) at 5 years and 72.9% (64.0%-79.9%) at 10 years. Gastrointestinal symptom rating scores and RAND-36 quality of life scores of patients with treatment success were similar to those of the general population but significantly lower in those with failed antireflux surgery. Of the patients available for long-term follow-up, 83% rated their operation a success. CONCLUSION: For the long-term, our results indicate decreasing effectiveness of laparoscopic antirefluxsurgery, although most of the patients seem to have an overall quality of life similar to that of the general population.

Current standard values of health utility scores for evaluating costeffectiveness in liver disease:A meta-analysis

BACKGROUND Health utility assessments have been developed for various conditions,including chronic liver disease.Health utility scores are required for socio-economic evaluations,which can aid the distribution of national budgets.However,the standard health utility assessment scores for specific health conditions are largely unknown.AIM To summarize the health utility scores,including the EuroQOL 5-dimensions 5-levels(EQ-5D-5L),EuroQol-visual analogue scale,short from-36(SF-36),RAND-36,and Health Utilities Index(HUI)-Mark2/Mark3 scores,for the normal population and chronic liver disease patients.METHODS A systematic literature search of PubMed and MEDLINE,including the Cochrane Library,was performed.Meta-analysis was performed using the RevMan software.Multiple means and standard deviations were combined using the StatsToDo online web program.RESULTS The EQ-5D-5L and SF-36 can be used for health utility evaluations during antiviral therapy for hepatitis C.HUI-Mark2/Mark3 indicated that the health utility scores of hepatitis B patients are roughly 30% better than those of hepatitis C patients.CONCLUSION The EQ-5D-5L is the most popular questionnaire for health utility assessments.Health assessments that allow free registration would be useful for evaluating health utility in patients with liver disease.