What are the results of surgical treatment of gastroesophageal reflux disease? Is symptom resolution permanent? What are the most frequent and most severe complications?
Janusz Jankowski, MD, PhD: Essentially, in expert centers you will find that 80% of patients will have some sort of benefit from Nissen fundoplication. In nonexpert centers it may be lower, like 70%. But regardless of where you get operated on, there will always be about 10% of patients who have no benefit. There will be another 10% of patients who will be worse off, and the commonest reason for that is because the sphincter becomes too tight with the gastric mucosa wrapped around it. These patients will have gastric bloats, they will not be able to burp up the gas, and they will feel bloated after meals quite commonly. So that is the most common minor symptom.
It has to be mentioned to patients that even the expert centers still report up to 1 in 1000 patients who die in the perioperative period with postoperative complications, which is quite serious for young people having the operation.
It also needs to be mentioned that even in the expert centers that have a response rate of 80%, approximately 1 in 4 of these patients will require proton pump inhibitors over the ensuing years.