Quality of life for patients with gastroesophageal re¯ux disease 2 years after laparoscopic fundoplication Evaluation of the results obtained during the initial experience S. Contini, 1 A. BerteleÂ, 2 G. Nervi, 2 R. Zinicola, 1 C. Scarpignato 3 1 Department of General Surgery and Organ Transplantation, School of Medicine and Dentistry, University of Parma, Maggiore University Hospital, Via Gramsci 14, 43100 Parma, Italy 2 Division of Gastroenterology and Digestive Endoscopy, Maggiore University Hospital, Parma, Italy 3 Laboratory of Clinical Pharmacology, School of Medicine and Dentistry, University of Parma, Italy Received: 29 November 2001/Accepted in ®nal form: 1 April 2002/Online publication: 20 June 2002 Abstract Background: Health-related quality of life HRQL) is signi®cantly aected by gastroesophageal re¯ux disease GERD), and its evaluation is emerging as a factor important to select treatment options for GERD. Anti- re¯ux laparoscopic surgery improves HRQL. The aim of this study was to compare the preoperative and medi- um-term postoperative HRQL in patients submitted to laparoscopic fundoplication during the initial experience to verify its possible in¯uence on HRQL outcomes. Methods: Clinical assessment, endoscopy, and a previ- ously validated HRQL index were performed before and 2 years after surgery in 32 patients who underwent at the beginning of our experience. Results: The esophageal mucosa returned to normal 2 years after laparoscopic fundoplication in 81% of the patients. Heartburn was absent or occasional in 93%, and 65% were free of antisecretory drugs. All postop- erative HRQL items were signi®cantly improved p < 0.0001), with the postoperative curve of HRQL scores superposable to those of healthy Italian subjects Italian normative sample). Conclusions: The initial phase of learning does not af- fect the improvement of HRQL observed after laparo- scopic antire¯ux surgery, which is consistent with durable relief of symptoms and endoscopic healing. Evaluation of HRQL should be added to, and probably could replace in most cases, the objective postoperative testing. Key words: Gastroesophageal re¯ux disease Ð Lapa- roscopic fundoplication Ð Learning curve Ð Quality of life During recent years, there has been a growing interest in measuring the quality of life and the patient's satisfaction as important factors in evaluating the success of either medical or surgical treatment [5, 8, 13, 15]. Measurement of health-related quality of life HRQL) is therefore be- coming an important endpoint for clinical trials. Gastroesophageal re¯ux disease GERD) signi®- cantly aects the HRQL of the patients [16], which has been reported to be improved by either medical [15] or surgical [6, 10, 13] treatment, both of which render burdening lifestyle modi®cations obsolete. Laparoscopic fundoplication seems to be highly eective in controlling symptoms of GERD [29], and can be considered an attractive alternative to medical therapy, especially in young ®tted patients. The traditional measures used to assess the outcome of a surgical treatment are mortality and morbidity rates, length of hospital stay, complications, and reso- lution of symptoms. From the aforementioned reports, the evaluation of HRQL after surgery is emerging as an additional factor important in determining the role of surgery in the treatment of GERD and in selecting a treatment option for these patients. It is now well established that either medical or surgical therapy does improve the quality of HRQL in patients with GERD [6, 11]. After the advent of laparoscopy, it also was shown [24] that laparoscopic antire¯ux surgery produces amelioration in re¯ux symptoms equivalent to that of the open approach, with similar improvement in HRQL outcomes. In the afore- mentioned studies, dierent questionnaires e.g., GERD-HRQL, gastrointestinal quality of life index [GIQLI], gastrointestinal symptoms rating scale [GSRS] and short form 36 [SF-36]) have been used, and all have given consistent results. Although it is clear that in expert hands and in re- ferral centers laparoscopic surgery is invariably followed Surg Endosc 2002) 16: 1555±1560 DOI: 10.1007/s00464-001-9223-2 Ó Springer-Verlag New York Inc. 2002 Correspondence to: S. Contini