Total or Posterior Partial Fundoplication in the Treatment of GERD

Mardani, J.; Lundell, Lars; Engström, Christer

doi:10.1097/sla.0b013e3182171c48

Cited by 62 publications

(25 citation statements)

References 23 publications

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“…Nevertheless, no trials have demonstrated a significant reduction in postoperative dysphagia rate or provided clear evidence to support routine application of LTF. [ 12 – 14 ] Memon et al [ 36 ] conducted a meta-analysis comparing laparoscopic anterior with posterior fundoplication, and the results of the study suggested laparoscopic anterior fundoplication was a better alternative to laparoscopic posterior fundoplication. However, it is not appropriate to generalize 2 types of partial fundoplication into 1 category and it would reduce the credibility of the results of the meta-analysis above.…”

Section: Discussionmentioning

confidence: 99%

“…Constructing a posterior partial fundoplication is an alternative approach. The outcomes of RCTs [ 12 , 13 ] and a meta-analysis [ 14 ] we conducted previously have not shown a significant reduction in postoperative dysphagia following posterior partial fundoplication and “tailored therapy” has not been supported based on preoperative esophageal motility.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

et al. 2017

Medicine

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Background:Laparoscopic Nissen fundoplication (LNF) has been the gold standard for the surgical management of Gastro-esophageal reflux disease (GERD). Laparoscopic anterior 180° fundoplication (180° LAF) is reported to reduce the incidence of postoperative complications while obtaining similar control of reflux. The present meta-analysis was conducted to confirm the value of the 2 techniques.Methods:PubMed, Medline, Embase, Cochrane Library, Springerlink, and China National Knowledge Infrastructure Platform databases were searched for randomized controlled trials (RCTs) comparing LNF and 180° LAF. Data regarding the benefits and adverse results of 2 techniques were extracted and compared using a meta-analysis.Results:Six eligible RCTs comparing LNF (n = 266) and 180° LAF (n = 265) were identified. There were no significant differences between LNF and 180° LAF with regard to operating time, perioperative complications, length of hospital stay, patient satisfaction, willingness to undergo surgery again, quality of life, postoperative heartburn, proton pump inhibitor (PPI) use, postoperative DeMeester scores, postoperative lower esophageal sphincter (LES) pressure, postoperative gas-bloating, unable to belch, diarrhea, or overall reoperation. LNF was associated with a higher prevalence of postoperative dysphagia compared with 180° LAF, while 180° LAF was followed by more reoperation for recurrent reflux symptoms.Conclusion:LNF and 180° LAF are equally effective in controlling reflux symptoms and obtain a comparable prevalence of patient satisfaction. 180° LAF can reduce the incidence of postoperative dysphagia while this is offset by a higher risk of reoperation for recurrent symptoms. The risk of recurrent symptoms should need to be balanced against the risk of dysphagia when surgeons choose surgical procedures for each individual with GERD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

et al. 2017

Medicine

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“…However, subgroup analyses suggested that differences in the prevalence of dysphagia between two techniques disappeared over time. Furthermore, two decades follow-up results of a RCT [ 38 ] comparing open Nissen and Toupet demonstrated no difference in the prevalence of postoperative complications. As a reasonable and accurate index for assessing the efficacy of surgical treatment for GERD [ 39 , 40 ], the patient satisfaction was high (≈90 %) and comparable between the two arms.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults

Chen

et al. 2016

BMC Gastroenterol

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BackgroundLaparoscopic Nissen fundoplication (LNF) is the most common surgical procedure for the surgical management of gastro-esophageal reflux disease (GERD). Laparoscopic Toupet fundoplication (LTF) has been reported to have a lower prevalence of postoperative complications yet still obtain a similar level of reflux control. We conducted a meta-analysis to confirm the value of LNF and LTF.MethodsPubMed, Medline, Embase, Cochrane Library and Springerlink were searched for randomized controlled trials (RCTs) comparing LNF and LTF. Data regarding the benefits and adverse results of two techniques were extracted and compared using a meta-analysis.ResultsEight eligible RCTs comparing LNF (n = 625) and LTF (n = 567) were identified. There were no significant differences between LNF and LTF with regard to hospitalization duration, perioperative complications, patient satisfaction, postoperative heartburn, regurgitation, postoperative DeMeester scores, or esophagites. A shorter operative time and higher postoperative lower esophageal sphincter pressure were associated with LNF. Prevalence of postoperative dysphagia, gas-bloating, inability to belch, dilatation for dysphagia and reoperation were higher after LNF, but subgroup analyses showed that differences with respect to dysphagia between LNF and LTF disappeared over time. Subgroup analyses did not support “tailored therapy” according to preoperative esophageal motility.ConclusionsLNF and LTF have equivalently good control of GERD and result in a similar prevalence of patient satisfaction. Based on current evidence, it is not rational or advisable to abandon LNF when choosing a surgical procedure for GERD.

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“…T he risk of developing gastroesophageal reflux disease (GERD) increases with the severity of the anatomical changes and dysfunctions of the barrier against reflux of gastric contents through the esophagogastric junction (EGJ). [1][2][3] One therapeutic option for patients with GERD is daily intake of proton pump inhibitors (PPIs) to control symptoms and prevent the esophageal mucosa from reflux-induced damage. As an alternative, there is one well-established therapeutic option, ie, laparoscopic antireflux surgery.…”

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confidence: 99%

Comparison of Laparoscopic 270° Posterior Partial Fundoplication vs Total Fundoplication for the Treatment of Gastroesophageal Reflux Disease

et al. 2019

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IMPORTANCE Restoration of the esophagogastric junction competence is critical for effective long-term treatment of gastroesophageal reflux disease. Surgical repair results in such restoration, but mechanical adverse effects seem unavoidable. Minimizing these adverse effects without jeopardizing reflux control is warranted. OBJECTIVE To determine whether partial fundoplication (PF) or total fundoplication (TF) is superior in laparoscopic antireflux surgery. DESIGN, SETTING, AND PARTICIPANTS In this double-blind, randomized clinical trial of 1171 patients scheduled for laparoscopic antireflux surgery at a single university-affiliated center

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Total or Posterior Partial Fundoplication in the Treatment of GERD

Abstract: Both a total and a partial posterior fundoplication maintain a high level of reflux control after 2 decades of follow up. The previously reported differences in mechanical side effects, in favor of the partial wrap, seemed to disappear over time.

Cited by 62 publications

References 23 publications

Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults

Comparison of Laparoscopic 270° Posterior Partial Fundoplication vs Total Fundoplication for the Treatment of Gastroesophageal Reflux Disease

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