Dyspeptic symptoms after laparoscopic large hiatal hernia repair and primary antireflux surgery for gastroesophageal reflux disease: a comparative study

Furnée EJ, Draaisma WA, Hazebroek EJ, van Lelyveld N, Smout AJ, Broeders IA.

BACKGROUND
Several patients with gastroesophageal reflux disease suffer from functional dyspepsia. After laparoscopic Nissen fundoplication, these symptoms persist in a substantial number of patients. We hypothesized that, due to a higher chance of vagal nerve impairment during extensive hernia sac resection and esophageal mobilization, dyspeptic symptoms are more frequent after laparoscopic large hiatal hernia (types II-IV) repair than after primary antireflux surgery.

METHODS
From January 2003 to December 2007, 60 consecutive patients who primarily underwent an antireflux fundoplication for gastroesophageal reflux disease and 22 consecutive patients who had large hiatal hernia repair with fundoplication for concomitant gastroesophageal reflux disease were included. According to a system combining frequency and severity, patients scored 8 dyspeptic symptoms. Additionally, symptoms presenting preoperatively were scored according to the Visick grading system.

RESULTS
In 43 of the 49 available patients (87.8%) who primarily underwent antireflux surgery and in all 20 available patients who had hiatal hernia repair, preoperative symptoms resolved or improved. Mean symptom scores of all dyspeptic symptoms after surgery were comparable between both cohorts. General quality of life was equal in both cohorts.

CONCLUSION
After laparoscopic large hiatal hernia repair, dyspeptic symptoms were present in similar frequencies as after primary antireflux surgery.