Short- and Long-Term Results of Laparoscopic Versus Open Anti-Reflux Surgery: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Published in: Journal of gastrointestinal surgery Vol. 18; no. 6; pp. 1077 - 1086
• Main Authors: Qu, Hui, Liu, Yao, He, Qing-si
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.06.2014; Springer Nature B.V
• Subjects: Clinical trials; Dysphagia; Esophagus; Gastroenterology; Gastroesophageal reflux; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - physiopathology; Gastroesophageal Reflux - surgery; Heartburn - etiology; Hospitals; Humans; Laparoscopy; Laparoscopy - adverse effects; Laryngopharyngeal Reflux - etiology; Length of Stay; Medicine; Medicine & Public Health; Meta-analysis; Operative Time; Original Article; Patient Satisfaction; Randomized Controlled Trials as Topic; Reoperation; Sick leave; Surgery; Systematic review; Time Factors; Treatment Outcome; China; Open anti-reflux surgery; Laparoscopic anti-reflux surgery; Gastroesophageal reflux disease
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-014-2492-6

Background There is an ongoing debate about whether laparoscopic anti-reflux surgery (LARS) or open anti-reflux surgery (OARS) is the better option for the surgical treatment of gastroesophageal reflux disease (GERD). This study was aimed to evaluate and compare the short- and long-term results of both surgical strategies by means of a systematic review and meta-analysis. Methods A systematic search of electronic databases (PubMed, Embase, The Cochrane Library) for studies published from 1970 to 2013 was performed. All randomized controlled trials (RCTs) that compared LARS with OARS were included. We analyzed the outcomes of each type of surgery over short- and long-term periods. Results Twelve studies met final inclusion criteria (total n  = 1,067). A total of 510 patients underwent OARS and 557 had LARS. The pooled analyses showed, despite of longer operation time, the hospital stay and sick leave were significantly reduced in the LARS group. Significant reductions were also observed in complication rates for the LARS group in both short (odds ratio (OR) 0.31, 95 % CI 0.17 to 0.56) and long-term periods (OR 0.24, 95 % CI 0.07 to 0.80). Although complaints of reflux symptoms were more frequent among LARS patients in the short-term follow-up, LARS achieved better control of reflux symptoms in the long-term period ( P <  0.05). Reoperation rate, patient’s satisfaction, and 24-h pH monitoring were all comparable between the two groups (all P  > 0.05). Conclusions LARS is an effective and safe alternative of OARS for the surgical treatment of GERD, which enables a faster convalescence, better control of long-term reflux symptoms, and with reduced risk of complications.