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<h5 class="section-title" id="d15216422e278">Question</h5>
<p id="d15216422e280">What is the recurrence rate of gastroesophageal reflux after
primary laparoscopic
antireflux surgery?
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<h5 class="section-title" id="d15216422e283">Findings</h5>
<p id="d15216422e285">In this retrospective cohort study of 2655 patients who underwent
primary laparoscopic
antireflux surgery for gastroesophageal reflux disease in 2005-2014, reflux recurrence
occurred in 17.7% (83.6% requiring long-term treatment with proton pump inhibitors
or histamine
<sub>2</sub> receptor antagonists, 16.4% undergoing secondary antireflux surgery).
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<h5 class="section-title" id="d15216422e291">Meaning</h5>
<p id="d15216422e293">Laparoscopic antireflux surgery was associated with a relatively
high rate of recurrent
gastroesophageal reflux disease requiring long-term medication or secondary antireflux
surgery, diminishing some of the benefits of the operation.
</p>
</div><p class="first" id="d15216422e296">This cohort study assesses the risk of recurrence
of gastroesophageal reflux after
laparoscopic antireflux surgery and risk factors for reflux recurrence.
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<h5 class="section-title" id="d15216422e300">Importance</h5>
<p id="d15216422e302">Cohort studies, mainly based on questionnaires and interviews,
have reported high
rates of reflux recurrence after antireflux surgery, which may have contributed to
a decline in its use. Reflux recurrence after laparoscopic antireflux surgery has
not been assessed in a long-term population-based study of unselected patients.
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<h5 class="section-title" id="d15216422e305">Objectives</h5>
<p id="d15216422e307">To determine the risk of reflux recurrence after laparoscopic
antireflux surgery and
to identify risk factors for recurrence.
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<h5 class="section-title" id="d15216422e310">Design and Setting</h5>
<p id="d15216422e312">Nationwide population-based retrospective cohort study 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.
Their records were linked to the Swedish Causes of Death Registry and Prescribed Drug
Registry.
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<h5 class="section-title" id="d15216422e315">Exposures</h5>
<p id="d15216422e317">Primary laparoscopic antireflux surgery due to gastroesophageal
reflux disease in
adults (>18 years).
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<h5 class="section-title" id="d15216422e320">Main Outcomes and Measures</h5>
<p id="d15216422e322">The outcome was recurrence of reflux, defined as use of antireflux
medication (proton
pump inhibitors or histamine
<sub>2</sub> receptor antagonists for >6 months) or secondary antireflux surgery.
Multivariable
Cox regression was used to assess risk factors for reflux recurrence.
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<h5 class="section-title" id="d15216422e328">Results</h5>
<p id="d15216422e330">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, 470 patients (17.7%) had reflux recurrence; 393 (83.6%) received
long-term antireflux medication and 77 (16.4%) underwent secondary antireflux surgery.
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). 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).
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<h5 class="section-title" id="d15216422e333">Conclusions and Relevance</h5>
<p id="d15216422e335">Among patients who underwent primary laparoscopic antireflux
surgery, 17.7% experienced
recurrent gastroesophageal reflux requiring long-term medication use or secondary
antireflux surgery. Risk factors for recurrence were older age, female sex, and comorbidity.
Laparoscopic antireflux surgery was associated with a relatively high rate of recurrent
gastroesophageal reflux disease requiring treatment, diminishing some of the benefits
of the operation.
</p>
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