PMID- 23470572
OWN - NLM
STAT- MEDLINE
DCOM- 20130603
LR  - 20220408
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 257
IP  - 5
DP  - 2013 May
TI  - Laparoscopic anterior 180-degree versus nissen fundoplication for 
      gastroesophageal reflux disease: systematic review and meta-analysis of 
      randomized clinical trials.
PG  - 850-9
LID - 10.1097/SLA.0b013e31828604dd [doi]
AB  - OBJECTIVE: To compare short- and long-term outcome after 180-degree laparoscopic 
      anterior fundoplication (180-degree LAF) with laparoscopic Nissen fundoplication 
      (LNF). SUMMARY OF BACKGROUND DATA: LNF is currently the most frequently performed 
      surgical therapy for gastroesophageal reflux disease. Alternatively, 180-degree 
      LAF has been alleged to reduce troublesome dysphagia and gas-related symptoms, 
      with similar reflux control. METHODS: MEDLINE, EMBASE, Cochrane Library, and web 
      of Knowledge CPCI-S were searched for randomized clinical trials comparing 
      primary 180-degree LAF with LNF. The methodological quality was evaluated to 
      assess bias risk. Primary outcomes were esophageal acid exposure, esophagitis, 
      heartburn score, dilatation for dysphagia, modified Dakkak dysphagia score 
      (0-45), and reoperation rate. Meta-analysis was conducted at 1 and 5 years. 
      RESULTS: Five distinct randomized clinical trials comparing 180-degree LAF (n = 
      227) with LNF (n = 231) were identified. At 1 year, the Dakkak dysphagia score 
      [2.8 vs 4.8; weighted mean difference: -2.25; 95% confidence interval (CI): -2.66 
      to -1.83; P < 0.001], gas bloating [11% vs 18%; relative risk (RR) 0.59; 95% CI: 
      0.36-0.97; P = 0.04], flatulence (14% vs 25%; RR: 0.57; 95% CI: 0.35-0.91; P = 
      0.02), inability to belch (19% vs 31%; RR: 0.63; 95% CI: 0.40-0.99; P = 0.05), 
      and inability to relieve bloating (34% vs 44%; RR: 0.74; 95% CI: 0.55-0.99; P = 
      0.04) were lower after 180-degree LAF. Esophageal acid exposure (standardized 
      mean difference: 0.19; 95% CI: -0.07 to 0.46; P = 0.15), esophagitis (19% vs 13%; 
      RR: 1.42; 95% CI: 0.69-2.91; P = 0.34), heartburn score (standardized mean 
      difference: 1.27; 95% CI:-0.36 to 2.90; P = 0.13), dilatation rate (1.4% vs 2.8%; 
      RR: 0.60; 95% CI: 0.19-1.91; P = 0.39), reoperation rate (5.7% vs 2.8%; RR: 2.08; 
      95% CI: 0.80-5.41; P = 0.13), perioperative outcome, regurgitation, proton pump 
      inhibitor (PPI) use, lower esophageal sphincter pressure, and patient 
      satisfaction were similar after 180-degree LAF and LNF. At 5 years, the Dakkak 
      dysphagia score, flatulence, inability to belch, and inability to relieve 
      bloating remained lower after 180-degree LAF. The 5-year heartburn score, 
      dilatation rate, reoperation rate, PPI use, and patient satisfaction were 
      similar. CONCLUSIONS: At 1 and 5 years, dysphagia and gas-related symptoms are 
      lower after 180-degree LAF than after 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-degree LAF for the surgical treatment of 
      gastroesophageal reflux disease.
FAU - Broeders, Joris A
AU  - Broeders JA
AD  - Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, 
      Woodville South, South Australia. joris.broeders@adelaide.edu.au
FAU - Roks, David J
AU  - Roks DJ
FAU - Ahmed Ali, Usama
AU  - Ahmed Ali U
FAU - Watson, David I
AU  - Watson DI
FAU - Baigrie, Robert J
AU  - Baigrie RJ
FAU - Cao, Zhanguo
AU  - Cao Z
FAU - Hartmann, Jens
AU  - Hartmann J
FAU - Maddern, Guy J
AU  - Maddern GJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Fundoplication/*methods
MH  - Gastroesophageal Reflux/*surgery
MH  - Humans
MH  - Laparoscopy/*methods
MH  - Models, Statistical
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
EDAT- 2013/03/09 06:00
MHDA- 2013/06/05 06:00
CRDT- 2013/03/09 06:00
PHST- 2013/03/09 06:00 [entrez]
PHST- 2013/03/09 06:00 [pubmed]
PHST- 2013/06/05 06:00 [medline]
AID - 10.1097/SLA.0b013e31828604dd [doi]
PST - ppublish
SO  - Ann Surg. 2013 May;257(5):850-9. doi: 10.1097/SLA.0b013e31828604dd.