Meta-Analysis

Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease

  1. J. A. J. L. Broeders1,
  2. F. A. Mauritz1,
  3. U. Ahmed Ali1,
  4. W. A. Draaisma1,
  5. J. P. Ruurda1,
  6. H. G. Gooszen1,
  7. A. J. P. M. Smout2,
  8. I. A. M. J. Broeders3,
  9. E. J. Hazebroek1,*

Article first published online: 16 JUL 2010

DOI: 10.1002/bjs.7174

Issue

British Journal of Surgery

British Journal of Surgery

Volume 97, Issue 9, pages 1318–1330, September 2010

Additional Information

How to Cite

Broeders, J. A. J. L., Mauritz, F. A., Ahmed Ali, U., Draaisma, W. A., Ruurda, J. P., Gooszen, H. G., Smout, A. J. P. M., Broeders, I. A. M. J. and Hazebroek, E. J. (2010), Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg, 97: 1318–1330. doi: 10.1002/bjs.7174

Author Information

  1. 1

    Department of Surgery, Gastrointestinal Research Unit of the University Medical Center Utrecht, Utrecht, The Netherlands

  2. 2

    Department of Gastroenterology, Gastrointestinal Research Unit of the University Medical Center Utrecht, Utrecht, The Netherlands

  3. 3

    Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands

*Department of Surgery, HP G04·228, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands

Publication History

  1. Issue published online: 28 JUL 2010
  2. Article first published online: 16 JUL 2010
  3. Manuscript Accepted: 11 MAY 2010

Funded by

  • University Medical Center Utrecht Alexandre Suerman

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (181K)

Abstract

Background:

Laparoscopic Nissen fundoplication (LNF) is currently considered the surgical approach of choice for gastro-oesophageal reflux disease (GORD). Laparoscopic Toupet fundoplication (LTF) has been said to reduce troublesome dysphagia and gas-related symptoms. A systematic review and meta-analysis of randomized clinical trials (RCTs) was performed to compare LNF and LTF.

Methods:

Four electronic databases (MEDLINE, Embase, Cochrane Library and ISI Web of Knowledge CPCI-S) were searched and the methodological quality of included trials was evaluated. Outcomes included recurrent pathological acid exposure, oesophagitis, dysphagia, dilatation for dysphagia and reoperation rate. Results were pooled in meta-analyses as risk ratios (RRs) and weighted mean differences.

Results:

Seven eligible RCTs comparing LNF (n = 404) with LTF (n = 388) were identified. LNF was associated with a significantly higher prevalence of postoperative dysphagia (RR 1·61 (95 per cent confidence interval 1·06 to 2·44); P = 0·02) and dilatation for dysphagia (RR 2·45 (1·06 to 5·68); P = 0·04). There were more surgical reinterventions after LNF (RR 2·19 (1·09 to 4·40); P = 0·03), but no differences regarding recurrent pathological acid exposure (RR 1·26 (0·82 to 1·95); P = 0·29), oesophagitis (RR 1·20 (0·78 to 1·85); P = 0·40), subjective reflux recurrence, patient satisfaction, operating time or in-hospital complications. Inability to belch (RR 2·04 (1·19 to 3·49); P = 0·009) and gas bloating (RR 1·58 (1·21 to 2·05); P < 0·001) were more prevalent after LNF.

Conclusion:

LTF reduces postoperative dysphagia and dilatation for dysphagia compared with LNF. Reoperation rate and prevalence of gas-related symptoms were lower after LTF, with similar reflux control. These results provide level 1a support for the use of LTF as the posterior fundoplication of choice for GORD. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

View Full Article (HTML) Get PDF (181K)