Surgical Outcomes and Quality of Life After Anti-reflux Surgery

Surgical Outcomes and Quality of Life After Anti-reflux Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Surgical Outcomes and Quality of Life After Anti-reflux Surgery Camila Haro, Nicolás Muniz, Juan Rabellino, Fernando Castelli, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3982791/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Gastro esophageal reflux disease (GERD) has an increasing incidence, ranging from 10% to 20% in western countries. Anti-reflux surgery is indicated in patients that cannot sustain a long-term proton pump inhibitor (PPI) treatment, those in whom it is not effective, and those who associate a hiatal hernia (HH). The aim of this study is to evaluate anti-reflux surgery results in our institution, and asses the patient’s postoperative quality of life. Methods : We analyzed all patients submitted to laparoscopic anti-reflux surgery at Médica Uruguaya Corporación de Asistencia Médica (MUCAM) over the last 13 years. A quality-of-life (QOL) questionnaire was performed to evaluate surgical outcomes. Results : 103 patients were included, 80% were female and the average age was 59 years. 70% presented with GERD symptoms and 65% had a type III or IV HH. A Nissen fundoplication was performed in 98% of patients and a Toupet fundoplication in the remaining 2%. There was no mortality or need for conversion. Five patients had an early stenosis; four required reoperation and one an endoscopic dilation. Six patients required a late reoperation. 92% of patients answered the QOL questionnaire. 21% of respondents presented postoperative dysphagia and 37% are currently under PPI treatment, but these only affects the QOL of 1% and 3% of patients, respectively. 91% of those surveyed are satisfied with their current situation. Discussion : Our results coincide with those presented in the literature, showing that anti-reflux surgery is a safe procedure, that has a high satisfaction rate among patients. Background Indications for anti-reflux surgery include patients with gastro esophageal reflux disease (GERD) that do not desire to receive prolonged medical treatment, those who present adverse effects of proton pump inhibitors (PPI), do not respond to this treatment, and patients with large hiatal hernias.(1) There has been an increase of GERD incidence, ranging from 10% to 20% in western countries, due to change of dietary habits, obesity and the prevalence of Helicobacter Pylori.(2) GERD is caused by a functional and anatomical alteration of the lower esophageal sphincter (LES). Functionally, altered esophageal peristalsis (usually secondary to reflux) often coexists with LES incompetence, with more frequent and prolonged relaxations than those found in healthy individuals. Normal LES anatomy involves an abdominal portion of the esophagus, subjected to intra-abdominal pressure, extrinsic compression by the diaphragmatic pillars, and the presence of the angle of His, which limits reflux.(2) A number of factors favor LES incompetence, such as high-fat diets, alcohol consumption and certain medications like calcium antagonists and anticholinergics. Furthermore, elevated intraabdominal pressures increase reflux, as seen in obese and pregnant patients.(2) Hiatal hernia usually predisposes gastro esophageal reflux, due to anatomical alterations of the esophagogastric junction, affecting LES functionality. However, there are patients with large hiatal hernias without evidence of reflux, that due to their size, warrant surgery because of the risk of developing complications such as incarceration and volvulus. These complications, although of low incidence, have high morbidity and mortality rates.(3) Longstanding GERD can cause alterations in the distal esophageal mucosa, from esophagitis, to intestinal metaplasia or dysplasia, lastly resulting in adenocarcinoma development.(2) There are multiple anti-reflux procedures that aim to restore the anatomy of the gastroesophageal junction and increase the LES pressure to prevent reflux. All of them involve certain extent of mediastinum dissection, hernia reduction, transection of the cephalic short vessels in order to achieve a free tension fundoplication, diaphragmatic pillar approximation, and the creation of a total or partial fundoplication.(1) The aim of this study is to evaluate the results of anti-reflux surgery in our institution, and asses the patient’s postoperative quality of life. Methods We analyzed all patients submitted to laparoscopic anti-reflux surgery at Médica Uruguaya Corporación de Asistencia Médica (MUCAM) over the last 13 years. Patient data was retrieved from a database and further information was acquired from medical records. Patients were surveyed by phone to assess their quality of life after surgery. Results were analyzed using IBM SPSS Statistics 25. Frequencies were compared by Pearson’s test, with a significance level of 0.05. The study was approved by our institutional review board and patient consent was acquired, both written from the surgery and telephonic when answering the questionnaire. Results 103 patients were included, 80% of them were female. The average age was 59 years, ranging from 30 to 81. 70% of patients presented with GERD symptoms, 55% had them exclusively, while 15% associated atypical symptoms. Patients were studied preoperatively with an upper endoscopy, esophagogram, esophageal pHmetry and manometry, except for those with large hiatal hernias in which the latter two studies could not be performed. These patients were further studied with a thoracoabdominal computed tomography. 65% of patients had a type III or IV hiatal hernia. A Nissen fundoplication was performed on 98% of patients, while the remaining 2% underwent a Toupet fundoplication. Early surgical complications included fundoplication stenosis in 5 patients (5%). Four of these patients required a reoperation; two of them had a release of the fundoplication, and the remaining two a conversion to a Toupet fundoplication. The fifth patient was managed with an endoscopic dilation. Four of these five patients had an altered esophageal motility in the preoperative manometry, and the remaining patient did not have the study performed. There was no mortality or need of conversion to open surgery. The average length of stay for uncomplicated patients was 1.6 days, while those with complications stayed for 7 days. Six patients (6%) required a late reoperation, due to hiatal hernia recurrence, migration of the fundoplication to the mediastinum, or persistence of GERD. In four of them a new Nissen fundoplication was performed. One patient required a gastric bypass, and the remaining patient, who had hernia incarceration and gastric necrosis, needed an atypical gastric resection. 92% of patients answered the quality-of-life questionnaire, with a median postoperative follow-up of 3.5 years. 21% of respondents said they presented with dysphagia symptoms after the surgery, but only 3% allege daily symptoms and 1% claim these lowers their quality of life. (Table 1) 59% of respondents refer they have no heartburn, while 5% have daily discomfort. (Table 2) 37% of those who answered the questionnaire are currently under PPI treatment, but only 3% claims this affects their quality of life. 91% of those surveyed allege to be satisfied with their current situation, 7% is neutral, and 2% is dissatisfied. (Table 3) Discussion The aim of anti-reflux surgery is to restore the anatomy and functionality of the LES. Functional results are usually evaluated using quality of life questionnaires.( 4 ) Postoperative symptoms that are usually evaluated include persistence of reflux symptoms, as heartburn and regurgitations, and dysphagia onset, due to a LES stricture.( 5 ) Nissen fundoplication is the most frequently performed anti-reflux procedure. However, recent reviews have shown no statistically significant differences between this procedure and partial fundoplications.( 1 ) A randomized clinical trial published in 2022 by Analatos et al., shows equal reflux symptom control when comparing Nissen and Toupet fundoplication, the former presenting a higher index of dysphagia during the first postoperative year, after which it resembles that of Toupet fundoplication.( 6 ) A meta-analysis published by Tristao and cols. in 2020 shows that 2.2% − 4.4% of patients require a revision surgery to rebuild the fundoplication, and 0.9% − 4.4% need esophageal dilation.( 5 ) Results in our study coincide with the consulted literature. We believe the need of an early reoperation due to postoperative dysphagia might be due to an inaccurate surgical technique, given by a stretched closure of the diaphragmatic crus or a tight fundoplication. This can also be a result of an incorrect selection of operative technique, by performing a Nissen fundoplication in patients with esophageal dyskinesia. As formerly mentioned, 80% of the patients that presented early dysphagia in our series had an altered esophageal motility, while the remaining had no preoperative manometry, possibly due to a large hiatal hernia that did not allow the correct positioning of the probe in order to perform the study. Two recent meta-analysis compare results of postoperative dysphagia after total and partial fundoplications, finding that Nissen fundoplication has a higher rate of early dysphagia than Toupet fundoplication, even though this does not result in a higher rate of reinterventions( 7 , 8 ). However, they do not clearly state whether these are early or late reinterventions or the type of intervention required, so we cannot draw accurate conclusions. Studies that evaluate long term results of anti-reflux surgery show 32% of patients still require PPI treatment 10 years after surgery,( 9 ) which coincides with the results obtained in our series. 91% of those surveyed declare the surgery has had a positive effect on their quality of life and therefore would recommend it to a family member. While revising the literature we find 70–90% of long-term satisfaction with surgical outcomes( 1 , 9 , 10 ), and 84% of patients recommending anti-reflux surgery.( 9 ) Conclusion Laparoscopic anti-reflux surgery is a replicable and secure procedure. Our surgical team has achieved a reintervention rate similar to those published internationally, as well as low morbidity and no mortality. 91% of surveyed patients refer a quality-of-life improvement after the surgery, and would therefore recommend it. These results are comparable with those published, showing anti reflux surgery has a low complication rate and high long term satisfaction levels. We emphasize the importance of a preoperative manometry in all patients to be submitted to an anti-reflux surgery, to rule out alterations in esophageal motility that may influence the operative technique. We believe a partial fundoplication must be considered in patients with an altered esophageal motility in order to avoid postoperative dysphagia. Declarations Author disclosure: Drs. Camila Haro, Nicolás Muniz, Juan Rabellino, Fernando Castelli and Marcelo Viola have no conflicts of interest or financial ties to disclose. Author Contribution CH took part in the methodology and writing of the manuscript.NM took part in the conceptualization of the project, reviewing of the manuscript and revising its technical content.JR took part in the project administration and data retrieval.FC took part in methodology and investigationMV took part in project conceptualization, methodology, supervision and manuscript revision. References Patti MG. An evidence-based approach to the treatment of gastroesophageal reflux disease. Vol. 151, JAMA Surgery. American Medical Association; 2016. p. 73–8. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut [Internet]. 2005 May [cited 2023 Aug 26];54(5):710. Available from: /pmc/articles/PMC1774487/ Dellaportas D, Papaconstantinou I, Nastos C, Karamanolis G, Theodosopoulos T. Large paraesophageal hiatus hernia: Is surgery mandatory? Chirurgia (Romania). 2018;113(6):765–71. Zéman Z, Rózsa S, Tihanyi T, Tarkó E. Psychometric documentation of a quality-of-life questionnaire for patients undergoing antireflux surgery (QOLARS). Surgical Endoscopy and Other Interventional Techniques. 2005;19(2):257–61. Tristão LS, Tustumi F, Tavares G, Bernardo WM. Fundoplication versus oral proton pump inhibitors for gastroesophageal reflux disease: a systematic review and meta-analysis of randomized clinical trials. Vol. 18, Esophagus. Springer Japan; 2021. p. 173–80. Analatos A, Håkanson BS, Ansorge C, Lindblad M, Lundell L, Thorell A. Clinical Outcomes of a Laparoscopic Total vs a 270° Posterior Partial Fundoplication in Chronic Gastroesophageal Reflux Disease: A Randomized Clinical Trial. JAMA Surg. 2022;157(6):473–80. Li G, Jiang N, Chendaer N, Hao Y, Zhang W, Peng C. Laparoscopic Nissen Versus Toupet Fundoplication for Short- and Long-Term Treatment of Gastroesophageal Reflux Disease: A Meta-Analysis and Systematic Review. Surgical Innovation. SAGE Publications Inc.; 2023. Lee Y, Tahir U, Tessier L, Yang K, Hassan T, Dang J, et al. Long-term outcomes following Dor, Toupet, and Nissen fundoplication: a network meta-analysis of randomized controlled trials. Vol. 37, Surgical Endoscopy. Springer; 2023. p. 5052–64. Campanello M, Westin E, Unosson J, Lindskog S. Quality of life and gastric acid-suppression medication 20 years after laparoscopic fundoplication. ANZ J Surg. 2020;90(1–2):76–80. Gunter RL, Shada AL, Funk LM, Wang X, Greenberg JA, Lidor AO. Long-Term Quality of Life Outcomes Following Nissen Versus Toupet Fundoplication in Patients with Gastroesophageal Reflux Disease. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2017;27(9):931–6. Tables Table 1 QOL CUESTTIONAIRE - DYSPHAGIA Symptoms n % No symptoms 74 79% Symptoms with no discomfort 9 10% Non daily discomfort 8 9% Daily discomfort 2 2% Daily discomfort that lowers quality of life 1 1% Total 94 100% Table 2 QOL CUESTTIONAIRE - HEARTBURN Symptoms n % No symptoms 59 63% Symptoms with no discomfort 19 20% Non daily discomfort 11 12% Daily discomfort 5 5% Total 94 100% Table 3 QOL CUESTTIONAIRE – OVERALL SATISFACTION Satisfaction with current status n % Satisfied 86 92% Neutral 7 7% Dissatisfied 1 1% Total 94 100% Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3982791","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":275131212,"identity":"ccbdfe72-3343-4cbc-a90e-8ac0f3c7a54f","order_by":0,"name":"Camila Haro","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBACAyBmBrOYmRsYPgBpNnbitTA2MM4AaWEmWgsDYwMzDwOCixOYs599+LiAwU5et52x8bPNr23yfMwMjB8+5uDWYtmTbmw8gyHZcNthxmbp3L7bhm3MDMySM7fhcdiBNDZpHoYDjEAtDdK5PbcZgVrYmHnxaTn/DKzFHmTLb8ue2/aEtdyA2JII1NImzfDjdiIRWp4xG88wSE4GabHsbbid3MbM2IzfL+fTGB8XVNjZbjt/+PCNH39u285vbz744SMeLVCNUJqxDUw2EFKPDP6QongUjIJRMApGCgAA50RMcS6X+gAAAAAASUVORK5CYII=","orcid":"","institution":"Médica Uruguaya Corporación de Asistencia Médica (MUCAM)","correspondingAuthor":true,"prefix":"","firstName":"Camila","middleName":"","lastName":"Haro","suffix":""},{"id":275131213,"identity":"f5835fc6-57f3-4884-9364-f271de40b7e1","order_by":1,"name":"Nicolás Muniz","email":"","orcid":"","institution":"Médica Uruguaya Corporación de Asistencia Médica (MUCAM)","correspondingAuthor":false,"prefix":"","firstName":"Nicolás","middleName":"","lastName":"Muniz","suffix":""},{"id":275131214,"identity":"e2c8cde5-116c-452a-b8e9-b2d06435fb25","order_by":2,"name":"Juan Rabellino","email":"","orcid":"","institution":"Médica Uruguaya Corporación de Asistencia Médica (MUCAM)","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"Rabellino","suffix":""},{"id":275131215,"identity":"ca4b7231-1997-4b27-850b-a7549e0ed923","order_by":3,"name":"Fernando Castelli","email":"","orcid":"","institution":"Médica Uruguaya Corporación de Asistencia Médica (MUCAM)","correspondingAuthor":false,"prefix":"","firstName":"Fernando","middleName":"","lastName":"Castelli","suffix":""},{"id":275131216,"identity":"5f5f581e-75a8-4f8b-97b5-876db1eeb98e","order_by":4,"name":"Marcelo Viola","email":"","orcid":"","institution":"Médica Uruguaya Corporación de Asistencia Médica (MUCAM)","correspondingAuthor":false,"prefix":"","firstName":"Marcelo","middleName":"","lastName":"Viola","suffix":""}],"badges":[],"createdAt":"2024-02-23 18:26:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3982791/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3982791/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55568500,"identity":"88a1619f-b3c7-4618-86ba-98543dbece22","added_by":"auto","created_at":"2024-04-30 04:43:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":269562,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3982791/v1/c956d8af-b15e-4333-bef8-dcea612a1600.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSurgical Outcomes and Quality of Life After Anti-reflux Surgery\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eIndications for anti-reflux surgery include patients with gastro esophageal reflux disease (GERD) that do not desire to receive prolonged medical treatment, those who present adverse effects of proton pump inhibitors (PPI), do not respond to this treatment, and patients with large hiatal hernias.(1)\u003c/p\u003e\n\u003cp\u003eThere has been an increase of GERD incidence, ranging from 10% to 20% in western countries, due to change of dietary habits, obesity and the prevalence of Helicobacter Pylori.(2)\u003c/p\u003e\n\u003cp\u003eGERD is caused by a functional and anatomical alteration of the lower esophageal sphincter (LES). Functionally, altered esophageal peristalsis (usually secondary to reflux) often coexists with LES incompetence, with more frequent and prolonged relaxations than those found in healthy individuals.\u003c/p\u003e\n\u003cp\u003eNormal LES anatomy involves an abdominal portion of the esophagus, subjected to intra-abdominal pressure, extrinsic compression by the diaphragmatic pillars, and the presence of the angle of His, which limits reflux.(2)\u003c/p\u003e\n\u003cp\u003eA number of factors favor LES incompetence, such as high-fat diets, alcohol consumption and certain medications like calcium antagonists and anticholinergics. Furthermore, elevated intraabdominal pressures increase reflux, as seen in obese and pregnant patients.(2)\u003c/p\u003e\n\u003cp\u003eHiatal hernia usually predisposes gastro esophageal reflux, due to anatomical alterations of the esophagogastric junction, affecting LES functionality. However, there are patients with large hiatal hernias without evidence of reflux, that due to their size, warrant surgery because of the risk of developing complications such as incarceration and volvulus. These complications, although of low incidence, have high morbidity and mortality rates.(3)\u003c/p\u003e\n\u003cp\u003eLongstanding GERD can cause alterations in the distal esophageal mucosa, from esophagitis, to intestinal metaplasia or dysplasia, lastly resulting in adenocarcinoma development.(2)\u003c/p\u003e\n\u003cp\u003eThere are multiple anti-reflux procedures that aim to restore the anatomy of the gastroesophageal junction and increase the LES pressure to prevent reflux. All of them involve certain extent of mediastinum dissection, hernia reduction, transection of the cephalic short vessels in order to achieve a free tension fundoplication, diaphragmatic pillar approximation, and the creation of a total or partial fundoplication.(1)\u003c/p\u003e\n\u003cp\u003eThe aim of this study is to evaluate the results of anti-reflux surgery in our institution, and asses the patient\u0026rsquo;s postoperative quality of life.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe analyzed all patients submitted to laparoscopic anti-reflux surgery at M\u0026eacute;dica Uruguaya Corporaci\u0026oacute;n de Asistencia M\u0026eacute;dica (MUCAM) over the last 13 years. Patient data was retrieved from a database and further information was acquired from medical records. Patients were surveyed by phone to assess their quality of life after surgery.\u003c/p\u003e\n\u003cp\u003eResults were analyzed using IBM SPSS Statistics 25. Frequencies were compared by Pearson\u0026rsquo;s test, with a significance level of 0.05.\u003c/p\u003e\n\u003cp\u003eThe study was approved by our institutional review board and patient consent was acquired, both written from the surgery and telephonic when answering the questionnaire.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e103 patients were included, 80% of them were female. The average age was 59 years, ranging from 30 to 81. 70% of patients presented with GERD symptoms, 55% had them exclusively, while 15% associated atypical symptoms.\u003c/p\u003e \u003cp\u003ePatients were studied preoperatively with an upper endoscopy, esophagogram, esophageal pHmetry and manometry, except for those with large hiatal hernias in which the latter two studies could not be performed. These patients were further studied with a thoracoabdominal computed tomography.\u003c/p\u003e \u003cp\u003e65% of patients had a type III or IV hiatal hernia. A Nissen fundoplication was performed on 98% of patients, while the remaining 2% underwent a Toupet fundoplication.\u003c/p\u003e \u003cp\u003eEarly surgical complications included fundoplication stenosis in 5 patients (5%). Four of these patients required a reoperation; two of them had a release of the fundoplication, and the remaining two a conversion to a Toupet fundoplication. The fifth patient was managed with an endoscopic dilation. Four of these five patients had an altered esophageal motility in the preoperative manometry, and the remaining patient did not have the study performed.\u003c/p\u003e \u003cp\u003eThere was no mortality or need of conversion to open surgery. The average length of stay for uncomplicated patients was 1.6 days, while those with complications stayed for 7 days.\u003c/p\u003e \u003cp\u003eSix patients (6%) required a late reoperation, due to hiatal hernia recurrence, migration of the fundoplication to the mediastinum, or persistence of GERD. In four of them a new Nissen fundoplication was performed. One patient required a gastric bypass, and the remaining patient, who had hernia incarceration and gastric necrosis, needed an atypical gastric resection.\u003c/p\u003e \u003cp\u003e92% of patients answered the quality-of-life questionnaire, with a median postoperative follow-up of 3.5 years. 21% of respondents said they presented with dysphagia symptoms after the surgery, but only 3% allege daily symptoms and 1% claim these lowers their quality of life. (Table\u0026nbsp;1)\u003c/p\u003e \u003cp\u003e59% of respondents refer they have no heartburn, while 5% have daily discomfort. (Table\u0026nbsp;2) 37% of those who answered the questionnaire are currently under PPI treatment, but only 3% claims this affects their quality of life.\u003c/p\u003e \u003cp\u003e91% of those surveyed allege to be satisfied with their current situation, 7% is neutral, and 2% is dissatisfied. (Table\u0026nbsp;3)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of anti-reflux surgery is to restore the anatomy and functionality of the LES. Functional results are usually evaluated using quality of life questionnaires.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003ePostoperative symptoms that are usually evaluated include persistence of reflux symptoms, as heartburn and regurgitations, and dysphagia onset, due to a LES stricture.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eNissen fundoplication is the most frequently performed anti-reflux procedure. However, recent reviews have shown no statistically significant differences between this procedure and partial fundoplications.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) A randomized clinical trial published in 2022 by Analatos et al., shows equal reflux symptom control when comparing Nissen and Toupet fundoplication, the former presenting a higher index of dysphagia during the first postoperative year, after which it resembles that of Toupet fundoplication.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA meta-analysis published by Tristao and cols. in 2020 shows that 2.2% \u0026minus;\u0026thinsp;4.4% of patients require a revision surgery to rebuild the fundoplication, and 0.9% \u0026minus;\u0026thinsp;4.4% need esophageal dilation.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eResults in our study coincide with the consulted literature. We believe the need of an early reoperation due to postoperative dysphagia might be due to an inaccurate surgical technique, given by a stretched closure of the diaphragmatic crus or a tight fundoplication. This can also be a result of an incorrect selection of operative technique, by performing a Nissen fundoplication in patients with esophageal dyskinesia.\u003c/p\u003e \u003cp\u003eAs formerly mentioned, 80% of the patients that presented early dysphagia in our series had an altered esophageal motility, while the remaining had no preoperative manometry, possibly due to a large hiatal hernia that did not allow the correct positioning of the probe in order to perform the study.\u003c/p\u003e \u003cp\u003eTwo recent meta-analysis compare results of postoperative dysphagia after total and partial fundoplications, finding that Nissen fundoplication has a higher rate of early dysphagia than Toupet fundoplication, even though this does not result in a higher rate of reinterventions(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, they do not clearly state whether these are early or late reinterventions or the type of intervention required, so we cannot draw accurate conclusions.\u003c/p\u003e \u003cp\u003eStudies that evaluate long term results of anti-reflux surgery show 32% of patients still require PPI treatment 10 years after surgery,(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) which coincides with the results obtained in our series.\u003c/p\u003e \u003cp\u003e91% of those surveyed declare the surgery has had a positive effect on their quality of life and therefore would recommend it to a family member. While revising the literature we find 70\u0026ndash;90% of long-term satisfaction with surgical outcomes(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and 84% of patients recommending anti-reflux surgery.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eLaparoscopic anti-reflux surgery is a replicable and secure procedure. Our surgical team has achieved a reintervention rate similar to those published internationally, as well as low morbidity and no mortality.\u003c/p\u003e \u003cp\u003e91% of surveyed patients refer a quality-of-life improvement after the surgery, and would therefore recommend it. These results are comparable with those published, showing anti reflux surgery has a low complication rate and high long term satisfaction levels.\u003c/p\u003e \u003cp\u003eWe emphasize the importance of a preoperative manometry in all patients to be submitted to an anti-reflux surgery, to rule out alterations in esophageal motility that may influence the operative technique.\u003c/p\u003e \u003cp\u003eWe believe a partial fundoplication must be considered in patients with an altered esophageal motility in order to avoid postoperative dysphagia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor disclosure:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDrs. Camila Haro, Nicol\u0026aacute;s Muniz, Juan Rabellino, Fernando Castelli and Marcelo Viola have no conflicts of interest or financial ties to disclose.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCH took part in the methodology and writing of the manuscript.NM took part in the conceptualization of the project, reviewing of the manuscript and revising its technical content.JR took part in the project administration and data retrieval.FC took part in methodology and investigationMV took part in project conceptualization, methodology, supervision and manuscript revision.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePatti MG. An evidence-based approach to the treatment of gastroesophageal reflux disease. Vol. 151, JAMA Surgery. American Medical Association; 2016. p. 73\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut [Internet]. 2005 May [cited 2023 Aug 26];54(5):710. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e/pmc/articles/PMC1774487/\u003c/span\u003e\u003cspan address=\"http:///pmc/articles/PMC1774487/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDellaportas D, Papaconstantinou I, Nastos C, Karamanolis G, Theodosopoulos T. Large paraesophageal hiatus hernia: Is surgery mandatory? Chirurgia (Romania). 2018;113(6):765\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZ\u0026eacute;man Z, R\u0026oacute;zsa S, Tihanyi T, Tark\u0026oacute; E. Psychometric documentation of a quality-of-life questionnaire for patients undergoing antireflux surgery (QOLARS). Surgical Endoscopy and Other Interventional Techniques. 2005;19(2):257\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrist\u0026atilde;o LS, Tustumi F, Tavares G, Bernardo WM. Fundoplication versus oral proton pump inhibitors for gastroesophageal reflux disease: a systematic review and meta-analysis of randomized clinical trials. Vol. 18, Esophagus. Springer Japan; 2021. p. 173\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnalatos A, H\u0026aring;kanson BS, Ansorge C, Lindblad M, Lundell L, Thorell A. Clinical Outcomes of a Laparoscopic Total vs a 270\u0026deg; Posterior Partial Fundoplication in Chronic Gastroesophageal Reflux Disease: A Randomized Clinical Trial. JAMA Surg. 2022;157(6):473\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi G, Jiang N, Chendaer N, Hao Y, Zhang W, Peng C. Laparoscopic Nissen Versus Toupet Fundoplication for Short- and Long-Term Treatment of Gastroesophageal Reflux Disease: A Meta-Analysis and Systematic Review. Surgical Innovation. SAGE Publications Inc.; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee Y, Tahir U, Tessier L, Yang K, Hassan T, Dang J, et al. Long-term outcomes following Dor, Toupet, and Nissen fundoplication: a network meta-analysis of randomized controlled trials. Vol. 37, Surgical Endoscopy. Springer; 2023. p. 5052\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampanello M, Westin E, Unosson J, Lindskog S. Quality of life and gastric acid-suppression medication 20 years after laparoscopic fundoplication. ANZ J Surg. 2020;90(1\u0026ndash;2):76\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGunter RL, Shada AL, Funk LM, Wang X, Greenberg JA, Lidor AO. Long-Term Quality of Life Outcomes Following Nissen Versus Toupet Fundoplication in Patients with Gastroesophageal Reflux Disease. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2017;27(9):931\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eQOL CUESTTIONAIRE - DYSPHAGIA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eNo symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e79%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eSymptoms with no discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eNon daily discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eDaily discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eDaily discomfort that lowers quality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e94\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e100%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Table 2\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eQOL CUESTTIONAIRE - HEARTBURN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eNo symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e63%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eSymptoms with no discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eNon daily discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eDaily discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e94\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e100%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eQOL CUESTTIONAIRE \u0026ndash; OVERALL SATISFACTION\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatisfaction with current status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003eDissatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.83300589390963%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.467583497053045%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e94\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.69941060903733%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e100%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3982791/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3982791/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cu\u003eBackground\u003c/u\u003e: Gastro esophageal reflux disease (GERD) has an increasing incidence, ranging from 10% to 20% in western countries. Anti-reflux surgery is indicated in patients that cannot sustain a long-term proton pump inhibitor (PPI) treatment, those in whom it is not effective, and those who associate a hiatal hernia (HH).\u003c/p\u003e\n\u003cp\u003eThe aim of this study is to evaluate anti-reflux surgery results in our institution, and asses the patient’s postoperative quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMethods\u003c/u\u003e: We analyzed all patients submitted to laparoscopic anti-reflux surgery at Médica Uruguaya Corporación de Asistencia Médica (MUCAM) over the last 13 years. A quality-of-life (QOL) questionnaire was performed to evaluate surgical outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eResults\u003c/u\u003e: 103 patients were included, 80% were female and the average age was 59 years. 70% presented with GERD symptoms and 65% had a type III or IV HH. A Nissen fundoplication was performed in 98% of patients and a Toupet fundoplication in the remaining 2%.\u003c/p\u003e\n\u003cp\u003eThere was no mortality or need for conversion. Five patients had an early stenosis; four required reoperation and one an endoscopic dilation. Six patients required a late reoperation.\u003c/p\u003e\n\u003cp\u003e92% of patients answered the QOL questionnaire. 21% of respondents presented postoperative dysphagia and 37% are currently under PPI treatment, but these only affects the QOL of 1% and 3% of patients, respectively. 91% of those surveyed are satisfied with their current situation.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDiscussion\u003c/u\u003e: Our results coincide with those presented in the literature, showing that anti-reflux surgery is a safe procedure, that has a high satisfaction rate among patients.\u003c/p\u003e","manuscriptTitle":"Surgical Outcomes and Quality of Life After Anti-reflux Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-29 21:05:16","doi":"10.21203/rs.3.rs-3982791/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"80aefbfe-7172-4c11-8e0a-652263fdc66b","owner":[],"postedDate":"February 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-30T04:41:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-29 21:05:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3982791","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3982791","identity":"rs-3982791","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}