Abstract
AimIn recent years, several studies with large sample sizes and recent follow-up data have been published comparing outcomes between laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication. It is now timely to be re-evaluated and synthesized long-term efficacy and adverse events of both total and partial posterior fundoplication.Materials and MethodsElectronic searches for RCTs comparing the outcome after laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication were performed in the databases of MEDLINE, EMBASE, and the Cochrane Center Register of Controlled Trials. The data of evaluation in positive and adverse results of laparoscopic Nissen fundoplication and laparoscopic Nissen fundoplication were extracted and compared using meta-analysis.Results13 RCTs were ultimately identified involving 814 (52.05%) and 750 (47.95%) patients who underwent laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication, respectively. The operative time, perioperative complications, postoperative satisfaction, recurrence, and the rates of medication adoption or re-operation due to recurrence were not significantly different between two groups. The two types of fundoplication both reinforced the anti-reflux barrier and elevated the lower esophageal sphincter pressure. However, rates of adverse results involving dysphasia, gas-bloat syndrome, inability to belch and re-operation due to severe dysphasia were significantly higher after LNF. In the subgroup analysis of wrap length≤2cm, laparoscopic Nissen fundoplication was associated with a significantly higher incidence of postoperative dysphagia. However, in the subgroup wrap length>2cm, the difference was not statistically significant.ConclusionLaparoscopic Toupet fundoplication might be the better surgery approach for gastroesophageal reflux disease with a lower rate of postoperative adverse results and equal effectiveness as Laparoscopic Nissen fundoplication.
Highlights
The lower esophageal sphincter (LES) plays an important role in the pathogenesis of gastroesophageal reflux disease (GERD) [1]
Five trials [7, 16, 20, 24,25] calculated the body mass index (BMI) of patients, which were similar within a range from 26 to 29 kg/m2
In preoperative normal esophageal motility (EM) subgroups, postoperative dysphagia occurred more commonly following Laparoscopic Toupet fundoplication (LTF) compared with Laparoscopic Nissen fundoplication (LNF) (LNF 17% vs. LTF 7.11%, RR 2.42, 95% CI [1.34, 4.34], p = 0.003)
Summary
The lower esophageal sphincter (LES) plays an important role in the pathogenesis of gastroesophageal reflux disease (GERD) [1]. In order to inhibit LES relaxation, fundoplication is considered to be an essential and important part of antireflux surgery. Laparoscopic Nissen fundoplication (LNF), a total wrap that surrounds the esophagus 360°, is the most commonly used, gold standard technique worldwide for antireflux surgery [2]. LNF is associated with a high incidence of postoperative dysphagia and gas-bloat syndrome [3,4]. Laparoscopic Toupet fundoplication (LTF), a 270° partial wrap, was introduced to counteract these side effects. An ongoing discussion has focused on the ideal approach to antireflux surgery, including durable reflux control, as well as minimal postoperative dysphagia and gas-related symptoms
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