We analyze the factors of laparoscopic anti-reflux surgery to improve the subjective symptoms of gastroesophageal reflux disease (GERD).

The clinical data of 92 patients who underwent laparoscopic anti-reflux surgery in the Department of Thyroid Breast Hernia Surgery of Shanghai Changzheng Hospital from January 2011 to December 2019 were retrospectively analyzed. Fundoplication included 54 cases of Nissen and 38 cases of Toupet. All patients were followed up by telephone for 108 months, including the improvement of reflux symptoms (acid reflux, heartburn), postoperative complications, satisfaction, etc. The recurrence of reflux and heartburn symptoms was used to evaluate the efficacy of anti-reflux surgery. χ² test, univariate analysis and logistic regression multivariate analysis were used to analyze the effects of gender, age (60 years old as the cut off value), PPI use time (30 months and 60 months as the cut off value), PPI reactivity (good/poor), hiatal hernia recurrence, operation method (Nissen/Toupet) and whether or not mesh was used on GERD related symptoms.

All operations were successfully completed. At the last follow-up, 11 cases had reflux recurrence and 21 cases had heartburn recurrence. Among them, 12 patients felt that the symptoms of esophagitis (reflux and heartburn) were not relieved. The overall satisfaction rate of operation was 81.52%. At the last follow-up, 16 cases had dysphagia of varying degrees, including 10 cases in Niseen group and 6 cases in Toupet group. The results of univariate analysis of reflux recurrence showed that gender, age, operation method, preoperative PPI use time and PPI reactivity has no correlation with reflux recurrence (P>0.05). The recurrence of hiatal hernia and the application of mesh were the influencing factors of postoperative reflux recurrence (P<0.05). Multivariate analysis showed that recurrence of hiatal hernia was independent influencing factor of postoperative reflux recurrence. Univariate analysis of heartburn recurrence showed that gender, age, operation method, preoperative PPI use time and mesh application has no correlation with heartburn recurrence (P>0.05), but PPI reactivity and hiatal hernia recurrence were the influencing factors of postoperative heartburn recurrence (P<0.05). Further multivariate analysis showed that PPI reactivity was the independent influencing factor of postoperative heartburn recurrence.

Laparoscopic anti-reflux surgery (fundoplication and hiatal hernia repair) is safe and effective in the treatment of GERD. For patients with poor preoperative PPI reactivity, the surgical indications should be more cautious.