Psychological factors are believed to play a role in
gastroesophageal reflux disease. It has previously been shown that preoperative illness behavior influences the outcome after laparoscopic Nissen
fundoplication. Between August 2001 and June 2004 we considered a partly subjective assessment of illness behavior when selecting patients with
gastroesophageal reflux disease for laparoscopic anterior partial (n = 77) or total
fundoplication (n = 90). A prospective questionnaire study of illness behavior was also undertaken and the results were correlated with clinical follow up after 12 months. There was a statistically significant difference in age (P < 0.001), primary esophageal peristalsis on manometry (P = 0.037) and two illness behavior category scores related to
hypochondriasis (P = 0.041 and P = 0.025) between laparoscopic anterior partial
fundoplication and Nissen total
fundoplication groups. Despite these differences, there was no significant correlation between preoperative illness behavior score and patient satisfaction in either group. There was a statistically significant negative correlation between the ability to express personal feelings and postoperative
heartburn score in those who had a laparoscopic anterior partial
fundoplication (P = 0.048). The clinical outcome in both groups was good to excellent in terms of postoperative
heartburn and satisfaction scores. A tailored approach in the choice of wrap, taking into account psychological factors preoperatively, is an appropriate strategy for laparoscopic
fundoplication.