Systematic review and meta-analysis of laparoscopic Nissen (posterior total)<i>versus</i>Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease

Broeders, Joris A.; Mauritz, Femke A.; Ali, Usama Ahmed; Draaisma, Werner A.; Ruurda, Jelle P.; Gooszen, Hein G.; Smout, A. J. P. M.; Broeders, Ivo A. M. J.; Hazebroek, Eric J.

doi:10.1002/bjs.7174

Cited by 260 publications

(165 citation statements)

References 98 publications

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…However, the Nissen procedure is often followed by troublesome effects. [1][2][3] To reduce the risk of these, partial fundoplications have been developed, and these modifications have been tested in randomized trials. 1;4-6 In the absence of late objective outcomes, some have questioned the durability of partial fundoplications, 7-10 even though longer term clinical outcomes from the trials actually support the application of anterior 180˚ and posterior 270˚ partial fundoplication techniques.…”

Section: Introductionmentioning

confidence: 99%

Objective Outcomes 14 Years After Laparoscopic Anterior 180-Degree Partial Versus Nissen Fundoplication

Broeders

Watson

et al. 2013

Annals of Surgery

View full text Add to dashboard Cite

Please note that any alterations made during the publishing process may not appear in this version. Objective Outcomes 14 Years after Laparoscopic Anterior 180˚ Partial versus Nissen FundoplicationResults from a Randomized Trial Results: 18 patients (8 anterior, 10 Nissen) underwent objective testing and had a symptom profile similar to those who did not (n=59) have testing. Total esophageal acid exposure time and the total number of acid and weakly acidic reflux episodes per 24 h were higher after anterior fundoplication than after Nissen fundoplication. Proximal, mid-esophageal and distal reflux were proportionately increased after anterior 180˚ fundoplication. The number of liquid and mixed reflux episodes were also higher after anterior fundoplication, which was accompanied by higher clinical heartburn scores. There were no differences in gas reflux, gastric belches and supragastric belches, which is in line with the observation that gasrelated symptoms were similar for both groups. Mean LES resting and relaxation nadir pressure were lower after anterior fundoplication, which was reflected by lower dysphagia scores. Patient satisfaction is similar after both procedures.Conclusions: At 14 years after randomization, this study demonstrated that acid, weakly acidic, liquid and mixed reflux episodes are more common after anterior 180˚ fundoplication compared to Nissen fundoplication. On the other hand, gas reflux and gastric belching and patient satisfaction are similar for both procedures. Mean LES resting and relaxation nadir pressure are lower after anterior fundoplication. Overall these findings suggests less effective 4Archived at Flinders University: dspace.flinders.edu.au 5 reflux control after anterior 180˚ partial fundoplication, offset by less dysphagia, leading to a clinical outcome which is equivalent to Nissen fundoplication at late follow-up.

show abstract

Section: Introductionmentioning

confidence: 99%

Objective Outcomes 14 Years After Laparoscopic Anterior 180-Degree Partial Versus Nissen Fundoplication

Broeders

Watson

et al. 2013

Annals of Surgery

View full text Add to dashboard Cite

show abstract

“…Ten patients underwent endoscopic dilatation with safe and excellent results. Therefore, this treatment modality should be considered in patients with dysphagia and decrease in quality of life 6,16 .…”

Section: Discussionmentioning

confidence: 99%

Identificação de fatores de risco pré-operatórios para disfagia pós-operatória persistente após cirurgia laparoscópica para doença do refluxo gastroesofágico

Ribeiro

Tercioti-Júnior

Souza-Neto

et al. 2013

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

-Background:Postoperative dysphagia is common after antireflux surgery and generally runs a self-limiting course. Nevertheless, part of these patients report long-term dysphagia. Inadequate surgical technique is a well documented cause of this result. Aim: This retrospective study evaluated the preoperative risk factors not surgery-related for persistent dysphagia after primary laparoscopic antireflux surgery. Methods: Patients who underwent laparoscopic antireflux surgery by the modified technique of Nissen were evaluated in the preoperative period retrospectively. Postoperative severity of dysphagia was evaluated prospectively using a stantardized scale. Dysphagia after six weeks were defined as persistent. Statistical tests of association and logistic regression were used to identify risk factors associated with persistent dysphagia. Results: A total of 55 patients underwent primary antireflux surgery by a single surgeon team. Of these, 25 patients had preoperative dysphagia (45,45%). Persistent postoperaive dysphagia was reported by 20 (36,36%). Ten patients (18,18%) required postoperative endoscopic dilatation for dysphagia. There was statistical association between satisfaction with surgery and postoperative dysphagia and requiring the use of antireflux medication after the procedure; and between preoperative dysphagia and postoperative dysphagia. Logistic regression identified significant preopertive dysphagia as risk factor for persistent postoperative dysphagia. No correlations were found with preoperative manometry. Conclusions: Patients with significant preoperative dysphagia were more likely to report persistent postoperative dysphagia. This study confirms that the current manometric criteria used to define esophageal dysmotility are not reliable to identify patients at risk for post-fundoplication dysphagia. Minucious review of the clinical history about the presence and intensity of preoperative dysphagia is important in the selection of candidates for antireflux surgery. RESUMO -Racional:Disfagia no pós-operatório é comum após a operação anti-refluxo. No entanto, uma parte dos pacientes relatam disfagia persistente, e técnica cirúrgica inadequada é uma causa bem documentada deste resultado. Objetivo: Este estudo retrospectivo avaliou os fatores de risco no pré-operatório para a disfagia persistente após operação antirefluxo por via laparoscópica. Métodos: Pacientes submetidos à operação anti-refluxo por via laparoscópica pela técnica de Nissen modificada foram avaliados no pré-operatório de forma retrospectiva. A severidade da disfagia pós-operatória foi avaliada prospectivamente usando uma escala estabelecida. A disfagia após seis semanas foi definida como persistente. Os testes estatísticos de associação e regressão logística foram utilizados para identificar os fatores de risco associados à disfagia persistente. Resultados: Um total de 55 pacientes foram submetidos ao procedimento por via laparoscópica por uma única equipe de cirurgiões. Destes, 25 doentes referiam disfagia pré-operató...

show abstract

“…There appears to be no advantage of one over another in terms of costs, cost-effectiveness balances between longer duration of surgery in open fundoplication versus higher instrumental cost in laparoscopically surgery. 14,15 In adults, it has been established that, compared to Nissen fundoplication, laparoscopic partial fundoplication causes less dysphagia, gas bloating and redo surgeries [16][17][18] Similar to adult findings, pediatric observations suggested that total and partial fundoplication produce equivalent GER control in children 19 dysphagia may occur less frequently in partial versus total fundoplications. 20 These conclusions are however based on limited data and uncertainty remains with respect to the optimal fundoplication technique.…”

Section: Fundoplication Techniquesmentioning

confidence: 92%

“…19,21 Post operative dysphagia is the most common complication, occurring in 0-33% of patients in the first months after fundoplication. 16 Recently, Schneider et al retrospectively assessed a group of 288 children who underwent Nissen fundoplication. 21 In this study 24 percent of patients required lower esophageal dilation because of dysphagia.…”

Section: Efficacy and Safety Of Fundoplicationmentioning

confidence: 99%

New Insights in Gastroesophageal Reflux, Esophageal Function and Gastric Emptying in Relation to Dysphagia Before and After Anti-Reflux Surgery in Children

Smits

Loots

Benninga

et al. 2013

Curr Gastroenterol Rep

View full text Add to dashboard Cite

Introduction Gastroesophageal reflux disease and treatment in childrenGastroesophageal reflux disease (GERD) in children is common, it affects approximately (?)3% of infants and <1% of older children. 1 GERD is clinically diagnosed when gastroesophageal reflux (GER) causes troublesome symptoms, and is a source of stress for both patients and caregivers. In infants, GERD is often mild and short lived, with >90% being free of GERD symptoms at the age of 18 months. 2,3 'Symptomatic GERD', that is a clinical diagnosis of GERD without corroborative evidence such as endoscopic evidence of esophagitis, can be challenging to treat. Standard treatment consists firstly of conservative measures: lifestyle changes, excess weight reduction, no exposure to tobacco smoke. In specific cases allergies are associated with GERD, and avoidance of allergens may relieve symptoms.If pharmacological therapy is considered, acid suppression is the first choice and using proton pump inhibitors (PPIs) is favored above H2-antagonists and on demand buffering agents. 2 However, acid suppression therapy in infants and children is now widely discouraged as PPIs, whilst proven effective in increasing gastric pH, do not reduce GERD symptoms. 4 The lack of therapeutic efficacy of acid suppressive therapy might be explained by the fact that acid suppression does not target the underlying mechanism of reflux which is transient lower sphincter relaxation (TLESR). 3,5 Acid suppression only turns acid GER into weakly acid GER, which may still cause troublesome symptoms. Although other therapeutic agents are being developed for adult GERD treatment (especially GABA(B) agonists and mGLUR5 antagonists), these have many sideeffects and are not yet tested in children. 6,7 Therefore, no pharmacological interventions aimed a reducing TLESRs are available.In patients with objective evidence of acid-related GERD, based on upper endoscopy, pH-metry and/or pH impedance measurement (pHMII), who experience severe symptoms or have esophagitis refractory to optimal medical therapy, anti-reflux surgery (fundoplication) may be a treatment of last resort. 8Indications for fundoplication are poorly defined in children 2,9,10 and there is no uniformity between hospitals in the approach to infants and children with pharmacological therapy resistant GERD. 11 Neurologically impaired children, children with a history of esophageal atresia 12 and children with respiratory alarm symptoms considered GERD-related (e.g. apnea, bronchiectasis, recurrent pneumonia) are more prone to undergo fundoplication. Fundoplication techniquesThe primary goal of anti-reflux surgery is to reduce GER without preventing passage into the stomach of swallowed substances. These conclusions are however based on limited data and uncertainty remains with respect to the optimal fundoplication technique. In addition prospective evidence is limited in terms of efficacy and complication rates between partial and total fundoplication. 19 Efficacy and safety of fundoplicationEfficacy and safety o...

show abstract

Systematic review and meta-analysis of laparoscopic Nissen (posterior total)versusToupet (posterior partial) fundoplication for gastro-oesophageal reflux disease

Cited by 260 publications

References 98 publications

Objective Outcomes 14 Years After Laparoscopic Anterior 180-Degree Partial Versus Nissen Fundoplication

Objective Outcomes 14 Years After Laparoscopic Anterior 180-Degree Partial Versus Nissen Fundoplication

Identificação de fatores de risco pré-operatórios para disfagia pós-operatória persistente após cirurgia laparoscópica para doença do refluxo gastroesofágico

New Insights in Gastroesophageal Reflux, Esophageal Function and Gastric Emptying in Relation to Dysphagia Before and After Anti-Reflux Surgery in Children

Contact Info

Product

Resources

About