Flatulence After Anti-reflux Treatment (FAART) Study

World J Surg. 2019 Dec;43(12):3065-3073. doi: 10.1007/s00268-019-05144-2.


Background: Flatulence is known to be a common side effect of laparoscopic fundoplication, yet the true incidence is unclear and its impact on patients' quality of life not well understood. This study aimed to assess the long-term incidence of flatulence, and its effect on quality of life, following fundoplication.

Methods: All patients who underwent primary laparoscopic fundoplication between 1999 and 2009 were identified from a prospectively maintained institutional database. A cross-sectional analysis of post-operative gastrointestinal symptoms and quality of life was performed using a symptom-specific questionnaire. Statistical analysis of outcomes stratified by sex and type of fundoplication was performed.

Results: 462 eligible patients were identified from the database, with follow-up obtained in 265 (57%). Median age at surgery was 53 (22-78) years. 137 patients (52%) were female. 138 (52%) underwent a 360° fundoplication, the remainder a partial fundoplication. At median follow-up of 11 (8-15) years, excessive flatulence was reported by 85%. Only 12% reported an adverse impact on social life, and 11% an adverse impact on quality of life. Flatulence was worse following a total than partial fundoplication, women reported more gas-related symptoms than men, yet neither sex nor wrap type had a significant impact on social life or quality of life.

Conclusions: The majority of patients report excessive flatulence at long-term follow-up after anti-reflux surgery, yet the impact on social life and quality life was small. There was no evidence to support tailoring of wrap type by sex to avoid gas-related symptoms. The authors advocate that all patients understand the inevitable side effects of fundoplication to help manage expectations from surgery.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Esophagitis, Peptic / etiology
  • Female
  • Flatulence / etiology*
  • Follow-Up Studies
  • Fundoplication / adverse effects*
  • Fundoplication / methods
  • Fundoplication / rehabilitation
  • Gastroesophageal Reflux / surgery*
  • Humans
  • Incidence
  • Laparoscopy / adverse effects
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Quality of Life
  • Radiography, Abdominal
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors
  • Surveys and Questionnaires
  • Treatment Outcome
  • Young Adult