Abstract
Aim: To evaluate Laparoscopic anterior 180° partial fundoplication for its good long-term relief forsymptoms of gastroesophageal reflux disease and association with adverse effects. Methods:Study design: Prospectively evaluated case series. Settings: Tertiary care centers Patients: Theclinical outcomes were determined for all patients who had undergone a laparoscopic anterior partialfundoplication by us between January 1, 2013 to March 31, 2021. Interventions: Clinical outcome,complications, and follow-up after laparoscopic anterior 180° partial fundoplication was obtainedusing a structured questionnaire. Results and Discussion: 228 procedures were performed. Theoutcome at 0 to 8 years (mean, 4 years) follow-up was determined for 195 patients. 1 death waslinked to the laparoscopic procedure and 2 patients died during follow-up due to unrelated causes.For 186 patients (95%) with clinical outcome data at late follow-up, gastroesophageal refluxsymptoms were significantly improved following surgery and were well controlled in 9 patients(4.5%). In a subset of 85 patients with more than 5 years of follow-up, relief of heartburn was foundin 59 patients (69%). Incidence and severity of heartburn were reduced after surgery in 22 patients(26%), decreased dyspepsia in 80 patients (94%). Normal belching was preserved in 84 patients(99%) and almost all patients were able to eat normally. Conclusion: Laparoscopic anterior 180°partial fundoplication is an effective procedure for the surgical treatment of gastroesophageal refluxand is associated with a high rate of patient satisfaction at late follow-up. Compared to Nissen'sfundoplication it is as good as control of recurrent reflux as well as reduced adverse effects. Thepatient goes home in 3-4 days. Hence we recommend it as the procedure of choice for refluxsymptoms.
Highlights
Fundoplication encompasses a well-established role within the treatment of gastroesophageal reflux disease
These findings suggest less effective reflux control after anterior 180° partial fundoplication, offset by less dysphagia, leading to a clinical outcome that is equivalent to Nissen fundoplication at late follow-up [15]
Systematic meta-analysis of randomized trials has shown that laparoscopic Nissen's fundoplication and 180° laparoscopic anterior fundoplication are effective in controlling reflux symptoms and obtain a comparable prevalence of patient satisfaction. 180° laparoscopic anterior fundoplication can reduce the incidence of postoperative dysphagia while this is offset by a higher risk of reoperation for recurrent symptoms
Summary
Fundoplication encompasses a well-established role within the treatment of gastroesophageal reflux disease. The procedure needs a learning curve and the duration of surgery is more with longer hospital stay and associated financial burden Due to these problems, anterior and posterior partial fundoplication techniques were developed. Mean lower esophageal sphincter (LES) resting and relaxation nadir pressure are lower after anterior fundoplication Overall, these findings suggest less effective reflux control after anterior 180° partial fundoplication, offset by less dysphagia, leading to a clinical outcome that is equivalent to Nissen fundoplication at late follow-up [15]. More studies have shown that at 1 and 5 years post-surgery, dysphagia and gas-related symptoms are lower after 180° laparoscopic anterior fundoplication than after laparoscopic Nissen's fundoplication, and esophageal acid exposure and esophagitis are similar, with no differences in heartburn scores, patient satisfaction, dilatations, and reoperation rate
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