Comparison of Nissen total and Lind partial transabdominal fundoplication in the treatment of gastro-oesophageal reflux

Walker, S. J.; Holt, Shirley; Sanderson, Cody J.; Stoddard, C. J.

doi:10.1002/bjs.1800790512

Cited by 79 publications

(30 citation statements)

References 16 publications

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“…They were published between 1974 and 2002, mean (range) quality score was 1.8 (1 to 5). Concerning the partial fundo- 53 and anterior fundoplication in one. 56 There were no perioperative deaths.…”

Section: Partial Versus Total Wrapmentioning

confidence: 99%

Evidence-Based Appraisal of Antireflux Fundoplication

Catarci

Gentileschi²,

Papi³

et al. 2004

Annals of Surgery

275

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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Section: Partial Versus Total Wrapmentioning

confidence: 99%

Evidence-Based Appraisal of Antireflux Fundoplication

Catarci

Gentileschi²,

Papi³

et al. 2004

Annals of Surgery

275

178

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“…Three studies were excluded by exclusion criteria: one study in children (10) , one comparing Hill fundoplication (7) and another that not include the principal outcomes studied (6) . Four studies were excluded by low methodological quality (14,18,33,36) . At the end, 10 RCTs were selected ( Figure 4).…”

Section: Resultsmentioning

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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“…Nine percent required re-operation, mostly because of intra-thoracic migration of the wrap, despite crural repair being performed selectively. Walker et al [33] randomised 52 patients between Nissen fundoplication and a Lind partial fundoplication procedure. Once more, symptomatic and objective reflux control was equivalent with both procedures.…”

Section: Results Of Total and Partial Fundoplicationmentioning

confidence: 99%

Update: Total versus Partial Laparoscopic Fundoplication

Watson

1998

Dig Surg

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Since the introduction of Nissen fundoplicaton in 1956, there has been concern about the incidence of troublesome mechanical complications, which has necessitated several modifications reducing the overall incidence to around 15%. Increasing knowledge of the pathophysiology of Nissen fundoplication has revealed that these complications are associated with a supracompetent high pressure zone (HPZ) which relaxes incompletely on swallowing and is associated with abolition of gas reflux and physiological acid reflux. Partial fundoplication procedures, which augment various constituents of the valvuloplasty component of competence and utilise a lesser degree of fundoplication, are associated with a very low incidence of mechanical complications, but debate has ensued that reflux control may be suboptimal and less durable than after Nissen fundoplication. However, several good, objective comparative studies and three prospective randomised trials have confirmed that a well conducted partial fundoplication procedure is at least as effective and durable in reflux control as Nissen fundoplication, whilst being associated with a lower incidence of mechanical complications. The debate has intensified since the advent of laparoscopic fundoplication, as several reports have highlighted the increased incidence of mechanical complications following Nissen fundoplication when performed laparoscopically compared with the open approach, with a higher incidence of impaired HPZ relaxation, believed to be associated with altered geometry and other factors inherent in laparoscopic fundoplication. This has resulted in re-operation rates for complications of laparoscopic Nissen fundoplication of 1–7%, and in the laparoscopic era, mechanical complications have overtaken recurrent reflux as the principal reason for revisional fundoplication. Several non-randomised series have shown that laparoscopic partial fundoplication procedures are associated with a similarly low incidence of mechanical complications and a negligible re-operation rate as at open operation, with retention of physiologial HPZ relaxation. These factors have resulted in increasing deployment of partial fundoplication procedures, and increasing support for the ‘tailored’ approach to anti-reflux surgery. Several prospective randomised studies between laparoscopic partial and total fundoplication procedures are currently in progress, and early results favour partial fundoplication because of the considerably lower incidence of mechanical complications. The continuance of these studies, as well as those underway which compare different partial fundoplication procedures and include economic and quality-of-life assessment, should enable the rational choice of the most appropriate laparoscopic anti-reflux procedure to be placed on a firm scientific footing.

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Comparison of Nissen total and Lind partial transabdominal fundoplication in the treatment of gastro-oesophageal reflux

Cited by 79 publications

References 16 publications

Evidence-Based Appraisal of Antireflux Fundoplication

Evidence-Based Appraisal of Antireflux Fundoplication

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

Update: Total versus Partial Laparoscopic Fundoplication

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