Laparoscopic antireflux surgery (LARS) is highly effective in the treatment of select patients with chronic cough

Abstract

Background: We present the largest single-center study to date of surgical and quality-of-life outcomes among patients treated with laparoscopic antireflux surgery for reflux-associated chronic cough. Extraesophageal manifestations of chronic gastroesophageal reflux are increasingly recognized, among which chronic cough may substantially compromise patient quality of life. Although the benefits of antireflux surgery are well documented in patients with typical symptoms of gastroesophageal reflux disease, less is known about the short-term impact of antireflux surgery on associated chronic cough.

Methods: Review of a prospectively maintained database of patients with gastroesophageal reflux disease was conducted, identifying individuals who underwent laparoscopic antireflux surgery between February 2012 and July 2018. Inclusion criteria consisted of identifying manifestations of chronic cough in patients diagnosed with gastroesophageal reflux disease as assessed by preoperative survey in addition to the physiologic diagnosis of pathologic reflux. Patient quality of life was analyzed up to 3 years postoperatively using 4 validated survey instruments: the Reflux Symptom Index, Gastroesophageal Reflux Disease-Health Related Quality of Life, Laryngopharyngeal Reflux Quality of Life, and Swallowing Quality of Life.

Results: We identified 232 patients (47 men, 185 women) with symptomatic chronic cough among their manifestations of underlying gastroesophageal reflux disease. Mean age, body mass index, and American Society of Anesthesiologists score were 61.7 years, 28.9 kg/m², and 2, respectively. We observed no 30-day wound-related complications, 17 patients (7.3%) experienced nonwound-related complications, and 2 patients (0.9%) required reoperation. Patients reported significant improvements in chronic cough and other manifestations of gastroesophageal reflux disease during an average of almost 3 years (Reflux Symptom Index -66%, Gastroesophageal Reflux Disease-Health Related Quality of Life -85%, Laryngopharyngeal Reflux Quality of Life -75%, and Swallowing Quality of Life +29%). Complete resolution of chronic cough was observed in 77% of respondents at follow-up, and 71% of postlaparoscopic antireflux surgery patients stopped antireflux medications. Symptom control was accompanied with a high rate of postoperative satisfaction among 71% patients at latest follow-up.

Conclusion: Chronic cough associated with gastroesophageal reflux disease after a thorough, objective medical workup can be expected to have an excellent rate of resolution and quality-of-life outcomes after laparoscopic antireflux surgery. A high-volume practice, objective documentation of gastroesophageal reflux disease, and a multidisciplinary approach are key in achieving optimal outcomes.