Evaluation of the Quality of Life in Pre- and Post-Operatory in Patients Submitted to Surgical Treatment of Reflux Disease and Hiato Hernia

Abstract

Gastroesophageal reflux disease affects 40% of the population in industrialized countries. GERD has a negative impact on the quality of life of affected patients. Although PPIs induce a good response in the control of symptoms, the need for prolonged use of the medication and the fact that more than a third of the patients have symptoms even after its correct use, make surgery, an alternative for the treatment of the disease. The aims of this study were to compare the quality of life related to GERD before and after MIS surgical treatment of GERD and/or hiatus hernia, and to analyze the results and com plications of the MIS treatment of GERD. Methods: For retrospective analysis , the electronic database of patients with indications for surgical treatment due to GERD and/or patients with sliding or paraesophageal hernias was examined. The study included patients from Hospital Universitário Gaffrée e Guinle and the Postgraduate Course in General Surgery at PUC-Rio (Rio de Janeiro, Brazil) who underwent surgery using video laparoscopy or robotic surgery between January 2013 and March 2020. This is an observational, longitudinal, descriptive study with retrospective analysis of the data. Surgical treatment was indicated due to incomplete response to clinical treatment, young age with persistent symptoms, or complications of GERD. Patients with hiatus and/or paraesophageal hernia with indication for surgical treatment were included. Results: The study evaluated 160 patients who underwent anti-reflux surgery by laparoscopic or robotic surgery in the period from 2013 to 2020. A total of 88 women and 72 men were operated, mean 46.6 ± 13.7 years. An improvement in the preoperative QS-GERD scores compared to the postoperative scores was observed (27.56 ± 10.93 vs 1.4 ± 2.47, p < 0.01). Additionally, it was observed that there was no association between worse prognosis and failure rate with gender, sex, age, body mass index, surgical technique, or the number of sutures on the fundoplication valve. The length of hospital stay was 24 hours in 74.2% of patients, 48 hours in 19.3%, and 72 hours in 4.6%, with a global median of 24 hours and a mean of 28.7 hours. No patient required blood transfusion ; none had early postoperative complications (seroma, wound infection, or eventration), or died. Conclusion: A significant drop in the QS-GERD score was found before and after the surgical treatment of GERD and or hiatus hernia. The MIS surgical treatment of GERD controlled the symptoms in most of the treated individuals, presenting a low rate of complications without mortality.