The effect of antireflux surgery on laryngeal symptoms, findings and voice parameters

The aim of this study was to evaluate the effect of laparoscopic antireflux surgery (LARS) on the laryngeal symptoms, physical findings and voice parameters of gastroesophageal reflux disease (GERD) patients with or without laryngopharyngeal reflux (LPR). Forty-one GERD patients predominantly with LPR symptoms (Group I) and twenty-six GERD patients without LPR symptoms (Group II) who had LARS were prospectively analysed before and 2 years after the surgery. Upper gastrointestinal endoscopy, 24-h ambulatory pH or MII-pH monitoring was performed in all cases. A reflux study group including specialists from five departments in a university hospital decided surgical indications. Patients were asked to fill out a validated LPR and voice quality questionnaire (Reflux Symptom Index and Voice Handicap Index-10). Laryngeal findings were evaluated and scored using a laryngoscopic grading scale [Reflux Finding Score (RFS)], by four blinded ENT specialists. GRBAS scale was done by a blinded otolaryngologist. Voice parameters were measured objectively via the Multi Dimensional Voice Programme (MDVP). The mean age was 45.8 ± 8.5 for Group I (24 men) and 48.9 ± 12.3 for Group II (16 men). The mean follow-up after LARS was 24.5 ± 1.3 months for Group I and 25.2 ± 1.1 months for Group II. The preoperative mean score of RSI was 22.8 ± 7.4 vs. 11.2 ± 6.6; RFS was 10.6 ± 2.3 vs. 5.7 ± 2.5 and VHI was 18.07 ± 4.4 vs. 10.86 ± 3.3 for Group I and II, respectively. The postoperative mean score of RSI was 12.9 ± 6.4 vs. 8.4 ± 4.5; RFS was 6.9 ± 2.0 vs. 4.5 ± 2.3 and VHI was 9.59 ± 4.4 vs. 7.95 ± 3.5 for Group I and II, respectively. Group I had significantly lower RSI and RFS scores following LARS compared to the preoperative scores. LARS successfully improved RFS, RSI and VHI in carefully selected patients with GERD, especially the signs and symptoms related to the larynx and voice. Although the indications for LARS are limited in patients with LPR symptoms, these results favor the decision-making period of LARS.