# Health-Related Quality of Life After Laparoscopic Nissen Fundoplication: A Long-Term Single-Center Cohort Analysis

## TL;DR

This study shows that laparoscopic Nissen fundoplication improves quality of life for GERD patients long-term, with high satisfaction and low reoperation rates.

## Contribution

The study provides long-term HRQoL data and satisfaction outcomes after laparoscopic Nissen fundoplication in a single-center cohort.

## Key findings

- 84.6% of patients reported satisfaction with the surgical outcome.
- 53.7% of patients discontinued proton pump inhibitor use after surgery.
- GERD-HRQL scores improved significantly in most domains, including heartburn and regurgitation.

## Abstract

Introduction and objectives: Gastro-oesophageal reflux disease (GERD) significantly impairs quality of life, particularly in patients with persistent symptoms despite optimal medical therapy. Laparoscopic Nissen fundoplication (LNF) is considered the gold-standard surgical treatment for well-characterised, refractory GERD. This study aimed to retrospectively evaluate long-term health-related quality of life (HRQoL), patient satisfaction, and proton pump inhibitor (PPI) use following LNF in a single-centre cohort.

Methods: All consecutive patients undergoing LNF at our institution between January 2009 and December 2019 were retrospectively reviewed. Demographic data, medication use, reoperations, and satisfaction were collected. Symptom burden was assessed using an adapted version of the validated GERD-HRQL questionnaire, administered by a structured telephone interview. Pre- and postoperative scores were compared using the Wilcoxon signed-rank test, with significance set at p < 0.05.

Results: Sixty-eight patients were included (79.4% female, median age 66 years). Median follow-up was 5.5 years. Postoperative discontinuation of PPIs occurred in 53.7% of patients; those who continued therapy were mostly receiving concomitant ulcerogenic medication. Satisfaction with surgical outcome was reported by 84.6% of respondents. GERD-HRQL scores, assessed with the adapted instrument, improved significantly across most domains, including heartburn, regurgitation, and symptom-related sleep and dietary interference (all p < 0.001). Dysphagia showed a non-significant trend towards improvement (p = 0.084). Reoperation was required in two patients (2.9%), and no procedure-related mortality occurred.

Conclusion: LNF offers durable symptom relief, improved HRQoL, and high long-term satisfaction, with low reoperation rates. Persistent PPI use and the non-significant trend in dysphagia highlight the importance of realistic preoperative counselling.