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

Abstract

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.

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

“…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.…”

“…What is more, surgical techniques of the included studies were identical and standardized, including repairment of hiatal hernia and construction of the fundoplication. As for the division of the short gastric vessels, RCTs [ 9 , 11 ] and the meta-analysis we undertook previously [ 14 ] showed that it did not alter outcomes. And the subgroup analyses did not support “tailored therapy” according to preoperative esophageal motility.…”

“…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.…”

Surgical treatment of hiatal hernia: A ten-year experience

“…Another important component is recognition of the socalled short esophagus, considered to be the major cause of the relapse. In these cases some authors recommend the "wedge-Collis" gastric repair which produces less tension on the hiatal repair and reduces a relapse of the disease 29 . In our study we did not note so-called short esophagus, nor performed "wedge-Collis" gastric repair.…”

Perspectives of Surgery for Benign Esophageal Diseases

“…b. In general, long-term follow-up outcomes of laparoscopic total (Nissen) and partial (Toupet-270 • ) fundoplication give similar results for treatment of GERD [7]. In the short term, dysphagia symptoms and the inability to belch may be higher in the Nissen procedure, but decreases with time.…”