Laparoscopic antireflux surgery: comparative study of Nissen, Nissen-Rossetti, and Toupet fundoplication

Pessaux, Patrick; Arnaud, J P; Ghavami, Behnaz; Jb, Flament; Trébuchet, G.; Meyer, C; Huten, N.; Champault, G

doi:10.1007/s004640000248

Cited by 65 publications

(45 citation statements)

References 16 publications

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“…Patti [43] analysed the long-term results of patients treated with partial versus total antireflux procedures: efficacy was higher for total fundoplication (recurrence of reflux in 4% of patients with total fundoplication versus 19% in patients with partial fundoplication), while the incidence of postoperative dysphagia was similar in both groups, even in patients with impaired esophageal peristalsis (8% Toupet versus 9% Nissen). Pessaux [44] , at a three-month follow-up, noted a dysphagia rate of 4.2% in patients treated with Nissen fundoplication versus 5.9% with Nissen-Rossetti wrap and 6.9% in those treated with Toupet. In a prospective randomized trial, Bessell [45] concluded that calibrating the antireflux wrap according to esophageal motility was not necessary, because the postoperative persistent dysphagia rate was similar between patients with total or partial wrap.…”

Section: Discussionmentioning

confidence: 99%

Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease

Pizza

Rossetti²,

Limongelli³

et al. 2007

WJG

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AIM: To demonstrate that age does not influence the choice of treatment for gastroesophageal reflux disease (GERD). We hypothesized that the outcome of total fundoplication in patients > 65 years is similar to that of patients aged ≤ 65 years. METHODS:Fo u r h u n d re d a n d t w e n ty c o n s e c ut i ve p a t i e n t s u n d e r w e n t t o t a l l a p a ro s c o p i c fu ndoplication for GERD. Three hundred and fifty-five patients were younger than 65 years (group Y), and 65 patients were 65 years or older (group E). T h e fo l l o w i n g e l e m e n t s w e re c o n s i d e re d : p re sence, duration, and severity of GERD symptoms; p re s e n c e o f a h i a t a l h e r n i a ; m a n o m e t r i c e va l uation, 24 h pH-monitoring data, duration of operation; incidence of complications; and length of hospital stay. RESULTS:Elderly patients more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in comparison with younger patients. A mild intensity of heartburn often leads physicians to underestimate the severity of erosive esophagitis. The duration of the operation was similar between the two groups. The incidence of intraoperative and postoperative complications was low and the difference was not statistically significant between the two groups. An excellent outcome was observed in 92.9% young patients and 91.9% elderly patients. CONCLUSION:Laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients.

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Section: Discussionmentioning

confidence: 99%

Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease

Pizza

Rossetti²,

Limongelli³

et al. 2007

WJG

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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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“…After the development of laparoscopic access described by Geagea 7 and Dallemagne et al 8 , the fi rst reports suggested the routine SGV division to reduce postoperative dysphagia 9,10,11 . However, other researches did not had the same results 12,13,14,15 . The randomized clinical trials (RCT) during laparoscopic era present now different standards of technique: the mobilization extension, number of divided vessels and the technique to make those divisions.…”

Section: Introductionmentioning

confidence: 84%

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation

et al. 2007

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PURPOSE: Evaluate short results after fundoplication procedure, concerning the division of short gastric vessels. METHODS: A prospective randomization of 90 patients with indication for hiatoplasty and total fundoplication with fundus mobilization was performed. They were divided into two groups: no SGV division (group A, n= 46) and with SGV division (Group B, n=44), although in both groups the gastric fundus was mobilized to perform a floppy valve. Early outcome with clinical follow up (1 year) was observed. RESULTS: Both groups were similar regarding preoperative parameters and severity of gastroesophageal reflux disease (GERD). No difference in morbidity was observed during hospital stay. Nevertheless, the median operating time was 80,2 minutes in group A and 94,1 minutes (p=0,021) in Group B. Transitory dysphagia during the first year was significantly lower in group B (46,6% versus 23,2%, p=0,012). However, in 12 months clinical outcome was similar in both groups (clinical symptoms of GERD, persistent dysphagia and reoperations). CONCLUSION: There was no improvement in routine division of SGV in total fundoplication procedure when the gastric fundus was mobilized.

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Laparoscopic antireflux surgery: comparative study of Nissen, Nissen-Rossetti, and Toupet fundoplication

Abstract: The results of this study do not differ significantly from the data reported in the literature, suggesting such surgical techniques are effective and well tolerated, and that both can be properly used in the treatment of GERD.

Cited by 65 publications

References 16 publications

Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease

Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease

Evidence-Based Appraisal of Antireflux Fundoplication

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation

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