Can Minimally Invasive Surgery Treat Heartburn Safely?

A minimally invasive surgical option for the treatment of heartburn is safer than had been originally believed for patients with gastroesophageal reflux disease (GERD) and may be a good alternative to long-term pharmacologic treatment, according to results of a recent study.

While both surgical and pharmacologic therapies are effective in treating patients with GERD, surgery remains an underused option, potentially due to the risk of postoperative adverse events.
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To examine the safety of laparoscopic fundoplication, researchers conducted a population-based nationwide cohort study of Swedish hospitals that performed the procedure between 1997 and 2013.

The primary outcomes of the study were all-cause 30- and 90-day mortality.

The annual rate of laparoscopic fundoplication decreased from 15.3 to 2.4 patients per 100,000 during the study period. All-cause 30- and 90-day mortality rates were 0.03% (n=3) and 0.08% (n=7), respectively. Overall, only 1 death was directly surgery-related. The presence of comorbidity and older age were both associated with increased risk of prolonged hospitalization but were not associated with the risk of reoperation.

“This population‐based study revealed very low mortality and reoperation rates following primary laparoscopic fundoplication in the working‐age population. The findings may influence clinical decision‐making in the treatment of severe GORD,” researchers concluded.

—Michael Potts

Reference:

Maret-Ouda J, Yanes M, Konings P, Brusselaers N, Lagergren J. Mortality from laparoscopic antireflux surgery in a nationwide cohort of the working‐age population [published online March 21, 2016]. Br J Surg. doi:10.1002/bjs.10141.