Five-year outcome after laparoscopic anterior partial versus Nissen fundoplication: four randomized trials
Broeders, Joris A
Roks, David J
Jamieson, Glyn G
Devitt, Peter G
Baigrie, Robert J
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Objective: To compare longer term (5-year) outcomes for reflux control and post-surgery side effects following laparoscopic anterior (90˚ and 180˚) partial vs. Nissen fundoplication for gastroesophageal reflux. Summary Background Data: Laparoscopic Nissen fundoplication is the most frequently performed surgical procedure for gastroesophageal reflux. It achieves excellent control of reflux, but in some patients is followed by troublesome side effects. To reduce the risk of side effects laparoscopic anterior partial fundoplication variants have been advocated, although some studies suggest poorer reflux control. Methods: From 1995 to 2003, 461 patients with gastroesophageal reflux were enrolled in 4 randomized controlled trials comparing anterior partial vs. Nissen fundoplication. Two trials evaluated anterior 180˚, and 2 anterior 90˚ partial fundoplication. The original trial data were combined and a re-analysis from original data was undertaken to determine outcomes at 5-years follow-up. Reflux symptom control and side effects were evaluated in a blinded fashion using standardized questionnaires, including 0-10 analog scores (0=no symptoms, 10=severe symptoms). Results: At 5 years, patients who underwent an anterior 90˚ or 180˚ partial fundoplication had less side effects compared with Nissen fundoplication and were equally satisfied with the overall outcome. Reflux control, measured by heartburn scores and antisecretory medication use, was similar for anterior 180˚ partial vs. Nissen fundoplication, but inferior after anterior 90˚ partial vs. Nissen fundoplication. Conclusions: Anterior 180˚ partial fundoplication achieves durable control of reflux symptoms and less side effects compared with Nissen fundoplication. Although reflux control following anterior 90˚ partial fundoplication appears less effective than after Nissen fundoplication. This data supports the use of anterior 180˚ partial fundoplication for the surgical treatment of gastroesophageal reflux.
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