ANZ journal of surgery · 2025
Does Patient Sex Influence the Symptom Pattern for Patients With Gastro-Oesophageal Reflux Disease and the Response of Symptoms to Fundoplication?
СтатьяНазвание и аннотация: Перевод в очереди
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Hammerschlag Joshua N, Roberts Ross H, McCombie Andrew
Аннотация
BACKGROUND: Several studies show that female patients experience lower satisfaction after anti-reflux surgery. We hypothesised that there is a pattern of symptoms common to female patients presenting with GORD and that it is these symptoms in particular that lead to inferior outcomes. We also hypothesised that these symptoms would respond differently to the different types of fundoplication.
METHODS: Pre-operative and post-operative questionnaires for all patients undergoing laparoscopic fundoplication were analysed. Pre-operative symptoms, improvement of symptoms, patient demographics and type of fundoplication were assessed.
RESULTS: The study evaluated 328 patients, 156 females and 172 males. Eighty-seven females (55.8%) and 135 males (78.5%) underwent a Nissen Fundoplication (p < 0.001) with the rest undergoing a posterior 270° (partial) fundoplication. Females reported most symptoms more frequently than males, and a predominantly female pattern of symptoms was identified. Bloating (p ≤ 0.001), asthma (p = 0.045), constipation (p = 0.010) and diarrhoea (p = 0.023) were significantly more associated with being female. At 18 months post-surgery, outcomes for patients presenting with 'female-pattern' symptoms were not improved by undertaking partial fundoplication when compared to Nissen fundoplication. The only symptom that was affected by the type of fundoplication was dysphagia, with a significant number of patients experiencing worsening of dysphagia after a Nissen fundoplication (p < 0.01).
CONCLUSION: There are certain symptoms that affect female patients who present with GORD more commonly than male patients, and this may contribute to lower satisfaction outcomes. Partial fundoplication does not appear to offer a significant advantage in improving these symptoms.
METHODS: Pre-operative and post-operative questionnaires for all patients undergoing laparoscopic fundoplication were analysed. Pre-operative symptoms, improvement of symptoms, patient demographics and type of fundoplication were assessed.
RESULTS: The study evaluated 328 patients, 156 females and 172 males. Eighty-seven females (55.8%) and 135 males (78.5%) underwent a Nissen Fundoplication (p < 0.001) with the rest undergoing a posterior 270° (partial) fundoplication. Females reported most symptoms more frequently than males, and a predominantly female pattern of symptoms was identified. Bloating (p ≤ 0.001), asthma (p = 0.045), constipation (p = 0.010) and diarrhoea (p = 0.023) were significantly more associated with being female. At 18 months post-surgery, outcomes for patients presenting with 'female-pattern' symptoms were not improved by undertaking partial fundoplication when compared to Nissen fundoplication. The only symptom that was affected by the type of fundoplication was dysphagia, with a significant number of patients experiencing worsening of dysphagia after a Nissen fundoplication (p < 0.01).
CONCLUSION: There are certain symptoms that affect female patients who present with GORD more commonly than male patients, and this may contribute to lower satisfaction outcomes. Partial fundoplication does not appear to offer a significant advantage in improving these symptoms.