Abnormal preoperative 24-hour pH score – predictor of favorable surgical outcomes

Abstract

Introduction. Currently the laparoscopic correction of gastroesophageal reflux disease (GERD) has demonstrated its utility, being able to control symptoms of disease in well-selected patients. Thus, were proposed several aspects of preoperative evaluation that predicts success, as typical symptoms of GERD and good response to acid suppression therapy. Preoperative 24-hour pH testing is controversial in patients who have typical symptomatic GERD, being reserved for patients with non-erosive GERD or with atypical symptoms. Aim of the study. To compare the clinical outcomes of laparoscopic antireflux surgery (LARS) for symptomatic GERD between patients with normal and abnormal preoperative pH testing. Materials and methods. Were selected 34 patients who underwent LARS for typical GERD between September 2016 and December 2017 at our hospital. All patients had preoperative pH testing and at least 3 months of post-operative follow-up. Two groups were formed: I - 18 patients with normal preoperative DeMeester score (DMS) (median 3.34, range 0.37 to 12.58) and II – 16 patients with abnormal preoperative DMS (median 28.70, range 16.96 to 96.13). Postoperative control of symptoms was evaluated using the Visick scale and HRQL-GERD questionnaire. Statistically significant difference was considered p<0.05. Results. Clinical outcomes were obtained from all patients at a median follow-up of 12 months (range 3 to 20 months) after surgery. Thirty from 34 patients (88.2%) were satisfied with surgery, having an excellent or good outcome (Visick scale). It's necessary to point that 3 from 18 (16%) patients of group I and only 1 from 16 (6.25%) from group II continued to have typical GERD symptoms (p<0.05). There was also statistically significant difference in postoperative Velanovich score (mean 6.6±1.1 vs. 2.4±0.68, p<0.05), group I patients having worse results. Conclusions. Symptomatic GERD patients with abnormal preoperative DMS have better outcomes after LARS compared with those having normal one. So, to minimize poor symptomatic outcomes after LARS, a routine preoperative pH testing is advised.