A Meta-Analysis of Randomized Controlled Trials to Compare Long-Term Outcomes of Nissen and Toupet Fundoplication for Gastroesophageal Reflux Disease

• Published in: PloS one Vol. 10; no. 6; p. e0127627
• Main Authors: Tian, Zhi-chao, Wang, Bin, Shan, Cheng-xiang, Zhang, Wei, Jiang, Dao-zhen, Qiu, Ming
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 29.06.2015; Public Library of Science (PLoS)
• Subjects: Archives & records; Bloat; Clinical trials; Complications; Deglutition Disorders - etiology; Deglutition Disorders - physiopathology; Dysphagia; Endoscopy; Esophageal sphincter; Esophageal Sphincter, Lower - physiopathology; Esophagus; Female; Fundoplication - adverse effects; Gastroenterology; Gastroesophageal reflux; Gastroesophageal Reflux - physiopathology; Gastroesophageal Reflux - surgery; Gastrointestinal Motility; Gastrointestinal surgery; Hospitals; Humans; Laparoscopy; Life assessment; Male; Meta-analysis; Middle Aged; Motility; Pathogenesis; Patient Satisfaction; Perioperative Care; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Pressure; Randomized Controlled Trials as Topic; Sphincter; Statistical analysis; Studies; Subgroups; Surgeons; Surgery; Time Factors; Treatment Outcome; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0127627

In 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. Electronic 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. 13 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≤2 cm, laparoscopic Nissen fundoplication was associated with a significantly higher incidence of postoperative dysphagia. However, in the subgroup wrap length>2 cm, the difference was not statistically significant. Laparoscopic 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.