Pirkanmaa Hospital District, M building, Small auditorium, address: Teiskontie 35.
Doctoral defence of Lic.Med. Perttu Neuvonen
The field of science of the dissertation is Surgery.
The opponent is docent Jari Ovaska (University of Turku). Professor Teuvo Tammela acts as the custos.
The language of the dissertation defence is Finnish.
Long-term results of antireflux surgery
The surgical treatment of reflux disease yields sustainable results
The gastroesophageal reflux disease has become the most common gastrointestinal disorder in the Western world. The currently prevailing surgical treatment, Nissen fundoplication, was originally developed in 1955, and the laparoscopic technique was utilised for the first time in 1991. In Finland, the major part of fundoplications are performed at central hospitals, but pragmatic studies presenting the long-term results of the operations performed as a part of routine clinical practice are few. The longest follow-up studies of this 60-year-old method are limited to twenty years.
This doctoral study analysed the impact of the introduction of the laparoscopic technique on the surgical treatment of the reflux disease in Kanta-Häme Central Hospital. In addition, the study examined the long-term results of laparoscopic Nissen fundoplication in routine clinical practice. Furthermore, to clarify the possible lifelong results of Nissen fundoplication, the study surveyed the results of a patient group that had undergone an open operation more than thirty years ago in Tampere University Hospital.
The results show that the number of anti-reflux operations significantly rose in Kanta-Häme Central Hospital after the introduction of the laparoscopic technique. The rise in the operation rates was considered a result of the broadening of the indications to include a wider range of patients. The operative technique became more standardised towards the end of the 1990s.
The health-related quality of life of the patients operated in Kanta-Häme Central Hospital was close to that of the Finnish general population ten years after the operation. The patient satisfaction was high, but dissatisfaction with the treatment was associated with decreased health-related quality of life. Flatulence and dysphagia were the most common side effects of the treatment while dysphagia was the most common problem among the dissatisfied. In 89 % of the patients, the anatomical surgical result was found to be intact and only 6 % of the patients were unsatisfied with the results. Also in the long term, disturbing typical reflux-related symptoms rarely occurred. The subjective and objective long-term results were comparable to those published about more specialised treatment units. For the first time, it was noted that the use of fibrin glue seemed to decrease the incidence of defective fundoplication wraps in the long term.
The results concerning patients who had undergone an open fundoplication in Tampere University Hospital more than thirty years previously suggested that a successful Nissen fundoplication may provide a lifelong control of reflux symptoms. The health-related quality of life of the patients was discovered to be comparable to that of the Finnish general population.
The results of this study suggest that laparoscopic Nissen fundoplication can provide sustainable surgical results also when carried out in routine clinical practice. In the case of successful surgery, fundoplication may give the patient a lifelong relief from reflux symptoms, but the potential risks and treatment-related side effects should be cautiously weighed when operative treatment is considered.
The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2283, Tampere University Press, Tampere 2017. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1785, Tampere University Press 2017.