Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360‡ fundoplication: Results of a prospective, randomized, clinical study

Lundell, Lars; Abrahamsson, Hasse; Ruth, Magnus; Sandberg, N; Olbe, L

doi:10.1007/bf01658980

Cited by 97 publications

(48 citation statements)

References 27 publications

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“…Six dealt with open fundoplication: 1 from Honolulu, USA; 44 1 multicenter from France; 45 1 from Stockolm, 46 and another from Goteborg, [47][48][49][50][51][52] Sweden; 1 from Liverpool, UK; 53 and 1 from Santiago, Chile. 54 The remaining 3 trials dealt with laparoscopic fundoplication: from Birmingham, USA; 55 from Adelaide, Australia; 56 and from Hamburg, Germany.…”

Section: Partial Versus Total Wrapmentioning

confidence: 99%

Evidence-Based Appraisal of Antireflux Fundoplication

Catarci

Gentileschi²,

Papi³

et al. 2004

Annals of Surgery

280

178

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Objective: To highlight the current available evidence in antireflux surgery through a systematic review of randomized controlled trials (RCTs). Summary Background Data: Laparoscopic fundoplication is currently suggested as the gold standard for the surgical treatment of gastroesophageal reflux disease, but many controversies are still open concerning the influence of some technical details on its results. Methods: Papers related to RCTs identified via a systematic literature search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes were abstracted and summarized across studies. Defined outcomes were examined for 41 papers published from 1974 to 2002 related to 25 RCTs. A meta-analysis was performed pooling the results as odds ratios (OR), rate differences (RD), and number needed to treat (NNT). Data given as mean and/or median values were pooled as a mean Ϯ SD (SD). Results: No perioperative deaths were found in any of the RCTs. Immediate results showed a significantly lower operative morbidity rate (10.3% versus 26.7%, OR 0.33, RD Ϫ12%, NNT 8), shorter postoperative stay (3.1 versus 5.2 days, P ϭ 0.03), and shorter sick leave (20.1 versus 35.8 days, P ϭ 0.03) for laparoscopic versus open fundoplication. No significant differences were found regarding the incidence of recurrence, dysphagia, bloating, and reoperation for failure at midterm follow-up. No significant differences in operative morbidity (13.1% versus 9.4%) and in operative time (90.2 versus 84.2 minutes) were found in partial versus total fundoplication. A significantly lower incidence of reoperation for failure (1.6% versus 9.6%, OR 0.21, RD Ϫ7%, NNT 14) was found after partial fundoplication, with no significant differences regarding the incidence of recurrence and/or dysphagia. Routine division of short gastric vessels during total fundoplication showed no significant advantages regarding the incidence of postoperative dysphagia and recurrence when compared with no division. The use of ultrasonic scalpel compared with clips or bipolar cautery for the division of short gastric vessels showed no significant effect on operative time, postoperative complications, and costs. Conclusions: Laparoscopic antireflux surgery is at least as safe and as effective as its open counterpart, with reduced morbidity, shortened postoperative stay, and sick leave. Partial fundoplication significantly reduces the risk of reoperations for failure over total fundoplication. Routine versus no division of short gastric vessels showed no significant advantages. A word of caution is needed when implementing these results derived from RCTs performed in specialized centers into everyday clinical practice, where experience and skills may be suboptimal.

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Section: Partial Versus Total Wrapmentioning

confidence: 99%

Evidence-Based Appraisal of Antireflux Fundoplication

Catarci

Gentileschi²,

Papi³

et al. 2004

Annals of Surgery

280

178

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“…Many report that after various antireflux procedures a great majority of patients can vent air from the stomach. Consequently when we specifically asked our patients whether they were able to belch after surgery, we found similar results and no difference between total and posterior partial fundoplication [99,100]. However, when we carefully examined these patients, we found that the latter less frequently complained of socially embarrassing flatulence due to a greater ability to vent air from the stomach.…”

Section: Complications Of Antireflux Surgerymentioning

confidence: 50%

Surgery of Gastroesophageal Reflux Disease: A Competitive or Complementary Procedure?

Lundell

2004

Dig Dis

Self Cite

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The management of chronic gastroesophageal reflux disease (GERD) has both been simplified and immensely improved by the development of modern medical therapies. These are built entirely on the concept of profound acid inhibition, which is very successful in a substantial proportion of GERD patients. Despite the efficacy of proton pump inhibitors (PPIs) some failures are unavoidable, and some patients experience incomplete control of major GERD symptoms on ordinary dosing of PPIs. Although the safety profile of PPIs is very reassuring, some people express some concern about the safety of drug treatment extending beyond 10 years especially when alternative therapeutic strategies are available. Some patients complain of alleged respiratory complications to severe reflux, and in those situations as well as in cases with e.g. Barrett’s esophagus, a complete control of reflux also incorporating the duodenal components in the refluxate may be warranted. In all those situations antireflux surgery can be considered indicated for the treatment of chronic GERD and thus be looked upon as complementary to medical therapy. Furthermore, some patients who have their GERD symptoms under control on PPIs still want to have an operation to avoid dependency on drugs. Hence in none of these clinical situations does antireflux surgery play a competitive role in relation to medical therapy. However, in the very few randomized clinical trials in which a head-to-head comparison has been completed between medical and surgical therapy, the latter has been found to be somewhat more effective in terms of reflux control. The other side of the coin is that antireflux surgery has some side effects that signify the importance of this surgery being performed in specialized centers.

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“…Open 18 16 180º posterior 2 years Lundell et al (21,22) Hagedorn et al (15) Open 54 56 180º posterior 11 years…”

Section: Methodsunclassified

Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? Systematic review and meta-analysis

Ramos

Lustosa²,

Almeida

et al. 2011

Arq. Gastroenterol.

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-Context -Although the high incidence of gastroesophageal reflux disease (GERD) in the population, there is much controversy in this topic, especially in the surgical treatment. The decision to use of a total or partial fundoplication in the treatment of GERD is still a challenge to many surgeons because the few evidence found in the literature. Objective -To bring more clear evidence in the comparison between total and partial fundoplication. Data sources -A systematic review of the literature and metaanalysis with randomized controlled trials accessed from MEDLINE, LILACS, Cochrane Controlled Trials Database was done. The outcomes remarked were: dysphagia, inability to belch, bloating, recurrence of acid reflux, heartburn and esophagitis. For data analysis the odds ratio was used with corresponding 95% confidence interval. Statistical heterogeneity in the results of the metaanalysis was assessed by calculating a test of heterogeneity. The software Review Manager 5 (Cochrane Collaboration) was utilized for the data gathered and the statistical analysis. Sensitive analysis was applied using only trials that included follow-up over 2 years. Results -Ten trials were included with 1003 patients: 502 to total fundoplication group and 501 to partial fundoplication group. The outcomes dysphagia and inability to belch had statistical significant difference (P = 0.00001) in favor of partial fundoplication. There was not statistical difference in outcomes related with treatment failure. There were no heterogeneity in the outcomes dysphagia and recurrence of the acid reflux. Conclusion -The partial fundoplication has lower incidence of obstructive side effects.

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Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360‡ fundoplication: Results of a prospective, randomized, clinical study

Cited by 97 publications

References 27 publications

Evidence-Based Appraisal of Antireflux Fundoplication

Evidence-Based Appraisal of Antireflux Fundoplication

Surgery of Gastroesophageal Reflux Disease: A Competitive or Complementary Procedure?

Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? Systematic review and meta-analysis

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