Five-Year Outcome After Laparoscopic Anterior Partial Versus Nissen Fundoplication

Broeders, Joris A.; Roks, David J.; Jamieson, Glyn G.; Devitt, Peter G.; Baigrie, R. J.; Watson, David I.

doi:10.1097/sla.0b013e31824b31ad

Cited by 42 publications

(43 citation statements)

References 28 publications

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“…However, reinterventions for dysphagia, recurrent reflux or herniation are probably inevitable and still needed in approximately 10 per cent of patients. As to what type of fundoplication is preferred, a recent meta‐analysis supports the use of a partial fundoplication given the lower rate of dysphagia and other side‐effects3. The present study is in line with this.…”

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confidence: 87%

Twenty years of experience with laparoscopic antireflux surgery (Br J Surg 2012; 99: 1415–1421)

Wijnhoven

2012

British Journal of Surgery

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supporting

confidence: 87%

Twenty years of experience with laparoscopic antireflux surgery (Br J Surg 2012; 99: 1415–1421)

Wijnhoven

2012

British Journal of Surgery

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“…This is in contrast with findings of RCTs that report that 90º LAF and 120º LAF are associated with inferior reflux control in both the short [43][44][45] and the long-term. 9,46 The two main differences between 90º LAF and 120º LAF versus 180º LAF are the reduced circumference of the wrap and the lack of fixation of the wrap to the right hiatal pillar. Fixation to the right hiatal pillar is probably the main factor that accounts for differences in the risk of recurrent reflux between various anterior fundoplications and probably accounts for the good results following 180º LAF demonstrated by this meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…7 Earlier this year the long-term results of randomized trials demonstrated that 180˚ LAF offers similar reflux control compared to LNF, whereas reflux control after 90˚ LAF is less effective than after LNF. 9 A systematic review that directly compared posterior 270˚ fundoplication to LNF concluded that it reduces dysphagia and gas-related symptoms compared LNF, with similar reflux control up to 5 years. 4 A similar meta-analysis comparing outcome after 180˚ LAF and LNF has not been reported previously.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, this year the long-term results of randomized trials demonstrated that 180˚ laparoscopic anterior fundoplication (LAF) offers similar reflux control compared to LNF, whereas reflux control after 90˚ LAF is less effective than after LNF. 9 Therefore, generalizing these two fundoplication types into one category in the setting of a meta-analysis is probably not appropriate. Comparing one partial fundoplication type head-to-head to LNF increases the validity of the analysis and facilitates application of the results in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Anterior 180-Degree Versus Nissen Fundoplication for Gastroesophageal Reflux Disease

et al. 2013

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Running headAnterior 180˚ versus Nissen fundoplication for GERD: a meta-analysis Word count 3161Archived at the Flinders Academic Commons: http://dspace.flinders.edu.au/dspace/ 2 Mini-AbstractSystematic review and meta-analysis demonstrating that laparoscopic anterior 180˚ fundoplication (180˚ LAF) reduces short and longer-term dysphagia and gas-related symptoms compared to laparoscopic Nissen fundoplication, with similar reflux control, dilatations and reoperation rate. These results lend level 1a support for the use of 180˚ LAF for the surgical treatment of GERD.Archived at the Flinders Academic Commons: http://dspace.flinders.edu.au/dspace/ 3 Structured abstractObjective: To compare short and longer-term outcome after laparoscopic anterior 180˚ fundoplication (180˚ LAF) versus laparoscopic Nissen fundoplication (LNF). Summary of background data:LNF is currently the most frequently performed surgical therapy for GORD. Alternatively, 180˚ LAF has been alleged to reduce troublesome dysphagia and gas-related symptoms, with similar reflux control. Methods Conclusions:At one and five years, dysphagia and gas-related symptoms are lower after 180˚ LAF compared with LNF, and esophageal acid exposure and esophagitis are similar, with no differences in heartburn scores, patient satisfaction, dilatations and reoperation rate.These results lend level 1a support for the use of 180˚ LAF for the surgical treatment of GERD.

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“…Initial results were promising, with good acid control and obvious reduction in dysphagia and bloating. Unfortunately, longterm results (5 years or more) found the 90°wrap to be less effective than a 360°fundoplication, and the procedure is now rarely performed in our centers for the treatment of severe gastro-esophageal reflux disease [15,16].…”

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confidence: 99%

What is the Best Anti‐Reflux Operation? All Fundoplications are Not Created Equal

Thompson

Watson

2015

World j. surg.

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This month's issue of the World Journal of Surgery presents a meta-analysis and systemic review of laparoscopic anterior versus posterior fundoplication for gastro-esophageal reflux disease [1]. The authors' aim was to answer the above (very important) question, which is asked of an upper gastrointestinal surgeon countless times by his/her patients. However, although the authors have prepared a comprehensive and thorough review, their study design has not answered this question. By not addressing the anatomical differences between varying degrees of fundoplication, misleading outcomes might have been generated that will not influence current surgical practice.Why is the design of this study problematic? Similar to a meta-analysis published in Annals of Surgery in 2011 [2] by a group from the Netherlands, the authors of the current study have grouped together 90°, 120°, and 180°wraps into an 'anterior' group, and 270°and 360°wraps into a 'posterior' group. The decision to combine these quite different operations into only two groups might have falsely minimized the side effects reported in the posterior group, and falsely decreased the apparent efficacy in the anterior group, thereby leading to the conclusion that laparoscopic posterior fundoplication is the best anti-reflux operation, which may not be true.A brief review of the history of laparoscopic fundoplication illustrates the differences between wraps. Initial reports describing the technique of a laparoscopic 360°( Nissen) fundoplication emerged in 1991 [3,4]. The principles of this operation closely followed the open technique for Nissen fundoplication, which at that time included division of the short gastric vessels, posterior closure of the diaphragmatic hiatus, and creation of a 1-2 cm 360°fun-doplication, calibrated by at least a 52 Fr intra-esophageal bougie. Results were very good, with excellent reflux control. However, adverse effects including dysphagia, inability to belch, gas bloat, and excessive flatulence were not uncommon, and a flood of research ensued (which continues today) to achieve an effective anti-reflux barrier with less side effects.The posterior 270°wrap was the first partial fundoplication to emerge in the laparoscopic era, with Cuschieri et al. describing their experience with the laparoscopic Toupet (270°) fundoplication in 1993 [5]. The 270°wrap is a 'semi-fundoplication' with intra-abdominal fixation of the fundus to the diaphragm, and placement of the fundus behind the esophagus. In 2010, it was compared to the Nissen 360°fundoplication in a well-constructed metaanalysis (compiling data from seven randomized controlled trials) [6]. The total 360°wrap was found to have a significantly higher prevalence of adverse effects, with equal reflux control to the 270°wrap. It was clear from this metaanalysis that the laparoscopic 270°wrap is not equivalent to the 360°wrap, and the author's decision (in the current meta-analysis) to group both of these wraps together is questionable.Reports of a laparoscopic anterior partial fundopli...

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Five-Year Outcome After Laparoscopic Anterior Partial Versus Nissen Fundoplication

Cited by 42 publications

References 28 publications

Twenty years of experience with laparoscopic antireflux surgery (Br J Surg 2012; 99: 1415–1421)

Twenty years of experience with laparoscopic antireflux surgery (Br J Surg 2012; 99: 1415–1421)

Laparoscopic Anterior 180-Degree Versus Nissen Fundoplication for Gastroesophageal Reflux Disease

What is the Best Anti‐Reflux Operation? All Fundoplications are Not Created Equal

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