Early outcomes and associated factors following laparoscopic fundoplication in Kampala Metropolitan Area-Uganda: A multicentre retrospective cohort study

Abstract

Background: Laparoscopic fundoplication has become the gold standard surgical option for PPI-refractory GERD and symptomatic hiatus hernia. A plethora of western studies have demonstrated favorable outcomes following Laparoscopic fundoplication. However, unfavorable outcomes have also been cited in other patients. An array of patient, surgeon and technique-related factors can influence these outcomes and these vary between settings. Although Laparoscopic fundoplication is increasingly becoming popular in Uganda and Sub-Saharan Africa, there is paucity of data regarding its early outcomes and associated factors in our setting. Objective: This study aims to describe the early outcomes and associated factors following Laparoscopic fundoplication in multiple centers within Kampala metropolitan area-Uganda. Methodology: A retrospective analysis of 119 eligible participants who underwent Laparoscopic Fundoplication between, 1st April 2019 and 1st April 2023 in five hospitals within Kampala metropolitan area was conducted utilizing consecutive sampling. The study examined the demographic characteristics, pre-operative symptoms, indication for surgery, endoscopic and intra-operative findings, and early outcomes of these patients up to the first post-operative clinic visit. Univariate and multivariate logistic regressions were employed in order to determine the factors associated with these early outcomes of laparoscopic fundoplication. Findings: 74% of the patients in this study were females, the mean age was 39.15 years (SD±12.13).The most common GERD symptoms were epigastric pain (91.30%) and heartburn (62.61%). 98.25 % of participants reported prior PPI use. The main indication for surgery was GERD with hiatus hernia (80.17%). The duration of surgery was greater than 2 hours for 55.46% of the participants but 63.64% had a short hospital stay of less than 3 days. 91.3% of patients reported some improvement by the first postoperative clinic visit. 43.59% of the participants developed transient dysphagia. Two participants were re-operated due to gastric volvulus with re-herniation and gastric perforation respectively. There was no recorded mortality. Prolonged surgery duration >2 hours was significantly associated with both; prolonged hospital stay > 3 dayswith p-value 0.015, 95% CI (1.238-7.01) and also less postoperative symptom improvement p-value 0.046, 95% CI (0.013-0.966). Conclusion: Symptomatic hiatus hernia was the main indication for laparoscopic fundoplication and most participants reporting excellent outcomes with short hospital stay and significant postoperative symptom improvement. Surgery duration greater than 2 hours in our setting was associated with both prolonged length of hospital stay and less postoperative symptom improvement