PMID- 19789920
OWN - NLM
STAT- MEDLINE
DCOM- 20100715
LR  - 20220317
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 24
IP  - 4
DP  - 2010 Apr
TI  - Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication 
      for gastroesophageal reflux disease: a prospective, randomized trial.
PG  - 924-32
LID - 10.1007/s00464-009-0700-3 [doi]
AB  - BACKGROUND: A prospective, randomized trial was performed to evaluate the 
      long-term outcome and patient satisfaction of laparoscopic complete 360 degrees 
      fundoplication compared with partial posterior 270 degrees fundoplication. 
      Partial fundoplication is purported to have fewer side effects with a higher 
      failure rate in controlling gastroesophageal reflux disease (GERD), while 
      complete fundoplication is thought to result in more dysphagia and gas-related 
      symptoms. METHODS: Patients were randomized to either laparoscopic Nissen (LN) or 
      laparoscopic Toupet (LT) fundoplication. Esophageal manometry, 24-h pH studies, a 
      detailed questionnaire, and a visual analog symptom (VAS) score were completed 
      before and after surgery. A final global outcome questionnaire was performed. 
      Failure was defined as recurrent GERD requiring revision surgery, maintenance 
      proton pump inhibitor (PPI) therapy, or surgery for postoperative dysphagia. 
      RESULTS: One hundred patients were randomized to LN (50) or LT (50). There were 
      no differences between LN and LT with respect to postoperative symptoms and 
      physiological variables except a higher wrap pressure in the LN group (15.2 vs. 
      12.0 mmHg). Dysmotility improved in 8/14 (57%) and 6/11 (54%) patients in the LN 
      group and the LT group, respectively, after surgery. There was no correlation 
      between dysmotility and dysphagia both pre- and post surgery in the two groups. 
      Recurrent symptoms of GERD occurred in 8/47 (17.0%) and 8/48 (16.6%) in the LN 
      group and the LT group, respectively. Outcome of patients with dysmotility was 
      similar to those with normal motility in both groups. At final follow-up (59.76 + 
      or - 24.23 months), in the LN group, 33/37 (89.1%) would recommend surgery to 
      others, 32/37 (86.4%) would have repeat surgery, and 34/37 (91.8%) felt they were 
      better off than before surgery. The corresponding numbers for the LT group 
      (follow-up = 55.18 + or - 25.97 months) were 35/36 (97.2%), 30/36 (83.3%), and 
      33/36 (91.6%). CONCLUSION: LN and LT are equally effective in restoring the lower 
      esophageal sphincter function and provide similar long-term control of GERD with 
      no difference in dysphagia. Esophageal dysmotility had no influence on the 
      outcome of either operation.
FAU - Shaw, John M
AU  - Shaw JM
AD  - Department of Surgery, J45 OMB, Health Sciences Faculty, University of Cape Town, 
      Anzio Road, Observatory 7925, Cape Town, South Africa. John.Shaw@uct.ac.za
FAU - Bornman, Philippus C
AU  - Bornman PC
FAU - Callanan, Marie D
AU  - Callanan MD
FAU - Beckingham, Ian J
AU  - Beckingham IJ
FAU - Metz, David C
AU  - Metz DC
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20090930
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Adult
MH  - Aged
MH  - Esophageal pH Monitoring
MH  - Female
MH  - Fundoplication/*methods
MH  - Gastroesophageal Reflux/*surgery
MH  - Humans
MH  - Laparoscopy/*methods
MH  - Male
MH  - Manometry
MH  - Middle Aged
MH  - Patient Satisfaction
MH  - Prospective Studies
MH  - Recurrence
MH  - Statistics, Nonparametric
MH  - Surveys and Questionnaires
MH  - Treatment Outcome
EDAT- 2009/10/01 06:00
MHDA- 2010/07/16 06:00
CRDT- 2009/10/01 06:00
PHST- 2009/05/08 00:00 [received]
PHST- 2009/08/10 00:00 [accepted]
PHST- 2009/10/01 06:00 [entrez]
PHST- 2009/10/01 06:00 [pubmed]
PHST- 2010/07/16 06:00 [medline]
AID - 10.1007/s00464-009-0700-3 [doi]
PST - ppublish
SO  - Surg Endosc. 2010 Apr;24(4):924-32. doi: 10.1007/s00464-009-0700-3. Epub 2009 Sep 
      30.