Characterization of Long-Term Outcomes After Toupet Fundoplication

Klapow, Joshua C.; Wilcox, C. Mel; Mallinger, A P; Marks, Robert D.; Heudebert, Gustavo R.; Centor, Robert M.; Lawrence, William Witherle; Richter, Joel E.

doi:10.1097/00004836-200205000-00006

Cited by 22 publications

(15 citation statements)

References 29 publications

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“…In contrast to patients before initial medical treatment, surgical patients do not expect an elimination of all perceived symptoms. This result is in relation to previous findings suggesting that even if not all symptoms are eliminated, patientsÕ satisfaction with treatment can be high and quality of life may be improved [25].…”

Section: Discussionsupporting

confidence: 88%

Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease

et al. 2005

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Section: Discussionsupporting

confidence: 88%

Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease

et al. 2005

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“…However, when the meta-analysis is done, we found a high statistical difference in this outcome. Although the higher incidence of recurrent acid reflux in follow-up of partial fundoplications studies (2,17) , we did not find statistical difference in the RCTs and in the meta-analysis. These aspects show the importance of the systematic review and meta-analysis in find more accurate evidence.…”

Section: Discussioncontrasting

confidence: 77%

“…Toupet in 1963 (34) , created a posterior partial fundoplication with 180º circumference. After him, other surgeons created many others partial fundoplications looking to reduce the post-operative dysphagia (19) , but the long-term results showed a rate of recurrence of the reflux higher than the Nissen procedure (17) . Many studies comparing total and partial fundoplications started to appear in the literature, but most of them failed to show a significant difference (24,38) .…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? Systematic review and meta-analysis

Ramos

Lustosa²,

Almeida

et al. 2011

Arq. Gastroenterol.

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-Context -Although the high incidence of gastroesophageal reflux disease (GERD) in the population, there is much controversy in this topic, especially in the surgical treatment. The decision to use of a total or partial fundoplication in the treatment of GERD is still a challenge to many surgeons because the few evidence found in the literature. Objective -To bring more clear evidence in the comparison between total and partial fundoplication. Data sources -A systematic review of the literature and metaanalysis with randomized controlled trials accessed from MEDLINE, LILACS, Cochrane Controlled Trials Database was done. The outcomes remarked were: dysphagia, inability to belch, bloating, recurrence of acid reflux, heartburn and esophagitis. For data analysis the odds ratio was used with corresponding 95% confidence interval. Statistical heterogeneity in the results of the metaanalysis was assessed by calculating a test of heterogeneity. The software Review Manager 5 (Cochrane Collaboration) was utilized for the data gathered and the statistical analysis. Sensitive analysis was applied using only trials that included follow-up over 2 years. Results -Ten trials were included with 1003 patients: 502 to total fundoplication group and 501 to partial fundoplication group. The outcomes dysphagia and inability to belch had statistical significant difference (P = 0.00001) in favor of partial fundoplication. There was not statistical difference in outcomes related with treatment failure. There were no heterogeneity in the outcomes dysphagia and recurrence of the acid reflux. Conclusion -The partial fundoplication has lower incidence of obstructive side effects.

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“…8,89,90 Surgeons began to perform partial fundoplications more frequently, 11,91 and the results of several nonrandomized trials did not confirm this hypothesis. [92][93][94] On the other hand, some authors still cast serious doubts regarding the effectiveness of partial fundoplication on the control of reflux, 93,[95][96][97] and others suggest that a floppy Nissen can be effective even in patients with defective esophageal peristalsis. 98,99 In this analysis (Table 6), partial fundoplication appeared to be a better procedure than total fundoplication, showing similar operative time, morbidity and recurrence rates, but a significantly reduced rate of reoperations for failure (1.6% versus 9.6%), mainly due to postoperative dysphagia (10.1% versus 16.8%).…”

Section: Annals Of Surgery • Volume 239 Number 3 March 2004mentioning

confidence: 99%

Evidence-Based Appraisal of Antireflux Fundoplication

Catarci

Gentileschi²,

Papi³

et al. 2004

Annals of Surgery

277

178

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Objective: To highlight the current available evidence in antireflux surgery through a systematic review of randomized controlled trials (RCTs). Summary Background Data: Laparoscopic fundoplication is currently suggested as the gold standard for the surgical treatment of gastroesophageal reflux disease, but many controversies are still open concerning the influence of some technical details on its results. Methods: Papers related to RCTs identified via a systematic literature search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes were abstracted and summarized across studies. Defined outcomes were examined for 41 papers published from 1974 to 2002 related to 25 RCTs. A meta-analysis was performed pooling the results as odds ratios (OR), rate differences (RD), and number needed to treat (NNT). Data given as mean and/or median values were pooled as a mean Ϯ SD (SD). Results: No perioperative deaths were found in any of the RCTs. Immediate results showed a significantly lower operative morbidity rate (10.3% versus 26.7%, OR 0.33, RD Ϫ12%, NNT 8), shorter postoperative stay (3.1 versus 5.2 days, P ϭ 0.03), and shorter sick leave (20.1 versus 35.8 days, P ϭ 0.03) for laparoscopic versus open fundoplication. No significant differences were found regarding the incidence of recurrence, dysphagia, bloating, and reoperation for failure at midterm follow-up. No significant differences in operative morbidity (13.1% versus 9.4%) and in operative time (90.2 versus 84.2 minutes) were found in partial versus total fundoplication. A significantly lower incidence of reoperation for failure (1.6% versus 9.6%, OR 0.21, RD Ϫ7%, NNT 14) was found after partial fundoplication, with no significant differences regarding the incidence of recurrence and/or dysphagia. Routine division of short gastric vessels during total fundoplication showed no significant advantages regarding the incidence of postoperative dysphagia and recurrence when compared with no division. The use of ultrasonic scalpel compared with clips or bipolar cautery for the division of short gastric vessels showed no significant effect on operative time, postoperative complications, and costs. Conclusions: Laparoscopic antireflux surgery is at least as safe and as effective as its open counterpart, with reduced morbidity, shortened postoperative stay, and sick leave. Partial fundoplication significantly reduces the risk of reoperations for failure over total fundoplication. Routine versus no division of short gastric vessels showed no significant advantages. A word of caution is needed when implementing these results derived from RCTs performed in specialized centers into everyday clinical practice, where experience and skills may be suboptimal.

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Characterization of Long-Term Outcomes After Toupet Fundoplication

Cited by 22 publications

References 29 publications

Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease

Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease

Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? Systematic review and meta-analysis

Evidence-Based Appraisal of Antireflux Fundoplication

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