Maret-Ouda J, et al. - This study determined the risk of gastroesophageal reflux recurrence after laparoscopic antireflux surgery and investigated risk factors for recurrence. Recurrent gastroesophageal reflux requiring long-term medication use or secondary antireflux surgery was experienced by 17.7% of patients who underwent primary laparoscopic antireflux surgery. Older age, female sex, and comorbidity were identified as risk factors for recurrence. In addition, a link was observed between laparoscopic antireflux surgery and a relatively high rate of recurrent gastroesophageal reflux disease requiring treatment, diminishing some of the benefits of the operation.

Methods

• This study is a nationwide population-based retrospective cohort study, conducted in Sweden between January 1, 2005, and December 31, 2014, based on all Swedish health care and including 2655 patients who underwent laparoscopic antireflux surgery according to the Swedish Patient Registry.
• The records of patients were linked to the Swedish Causes of Death Registry and Prescribed Drug Registry
• Primary laparoscopic antireflux surgery due to gastroesophageal reflux disease in adults (>18 years) served as the exposures.
• The outcome was recurrence of reflux, defined as use of antireflux medication (proton pump inhibitors or histamine2 receptor antagonists for >6 months) or secondary antireflux surgery.
• Risk factors for reflux recurrence were assessed using multivariable Cox regression.

Results

• Findings demonstrated that among all 2655 patients who underwent antireflux surgery (median age, 51.0 years; interquartile range, 40.0-61.0 years; 1354 men [51.0%]) and were followed up for a median of 5.6 years, reflux recurrence was seen in 470 patients (17.7%) ; 393 (83.6%) received long-term antireflux medication and 77 (16.4%) underwent secondary antireflux surgery.
• Researchers observed that risk factors for reflux recurrence included female sex (hazard ratio [HR], 1.57 [95% CI, 1.29-1.90]; 286 of 1301 women [22.0%] and 184 of 1354 men [13.6%] had recurrence of reflux), older age (HR, 1.41 [95% CI, 1.10-1.81] for age ≥61 years compared with ≤45 years; recurrence among 156 of 715 patients and 133 of 989 patients, respectively), and comorbidity (HR, 1.36 [95% CI, 1.13-1.65] for Charlson comorbidity index score ≥1 compared with 0; recurrence among 180 of 804 patients and 290 of 1851 patients, respectively).
• In addition, data reported that hospital volume of antireflux surgery was not associated with risk of reflux recurrence (HR, 1.09 [95% CI, 0.77-1.53] for hospital volume ≤24 surgeries compared with ≥76 surgeries; recurrence among 38 of 266 patients [14.3%] and 271 of 1526 patients [17.8%], respectively).