Predictors of outcome in 100 consecutive laparoscopic antireflux procedures

Background: Published success rates for surgical intervention in gastroesophageal reflux disease exceed 90%. The goal of this study was to determine if any preoperative factors could accurately predict postoperative symptom relief. Methods: One hundred consecutive patients undergoing laparoscopic antireflux surgery completed a detailed preoperative questionnaire, and underwent endoscopy, manometry, and 24-hour esophageal pH monitoring. Two surgeons performed all procedures in a standardized fashion. At least 2 months following operative intervention, a single interviewer, blinded to all preoperative information and procedure performed, recorded Visick and Gastroesophageal Reflux Disease–Health-Related Quality of Life scores for all patients. All follow-up was performed within 3 years of antireflux procedure. Results: The surgical success rate, as defined by Visick scores of 1-2, was 91%. Three variables were predictive of postoperative success: age <50, presence of typical symptoms at presentation, and complete resolution of symptoms with acid suppression therapy. Conclusion: The study shows that surgical strategies can reproducibly control gastroesophageal reflux disease symptoms in more than 90% of patients. The optimal surgical candidate is a patient under the age of 50 whose typical symptoms completely resolve with acid suppression therapy.