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Randomized controlled trial of laparoscopic anterior 180° partial versus posterior 270° partial fundoplication
Author(s) -
Daud Wan Najmi Wan,
Thompson Sarah K.,
Jamieson Glyn G.,
Devitt Peter G.,
Martin Ian J. G.,
Watson David I.
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12476
Subject(s) - medicine , heartburn , dysphagia , reflux , randomized controlled trial , surgery , patient satisfaction , adverse effect , disease
Background Previous trials show good outcomes following anterior and posterior partial versus N issen fundoplication for gastro‐oesophageal reflux. However, it is unclear which partial fundoplication performs best. This study compared anterior 180° versus posterior 270° fundoplication. Methods At three hospitals, patients were randomized to anterior 180° versus posterior 270° partial fundoplication, and clinical outcomes were determined using a structured questionnaire at 3, 6 and 12 months. Heartburn, dysphagia and satisfaction were assessed using 0–10 analoue scales, and adverse outcomes and side effects were determined. Endoscopy, manometry and pH monitoring were performed 6 months after surgery. Results Forty‐seven patients were randomized to anterior ( n = 23) versus posterior ( n = 24) fundoplication. Clinical outcomes for 93–98% of patients were available at each follow‐up point. At 12 months, the mean heartburn score was higher following anterior fundoplication (2.7 versus 0.8, P = 0.045), although differences were not significant at earlier follow‐up. Conversely, following posterior fundoplication, patients were less able to belch at 3 (56% versus 16%, P = 0.013) and 6 months (43% versus 9%, P = 0.017). No significant differences were demonstrated for dysphagia. Both groups had high rates of satisfaction with the outcome – 85% versus 86% satisfied at 12 months follow‐up. Conclusion Both partial fundoplications are effective treatments for gastro‐oesophageal reflux. Posterior partial fundoplication is associated with less reflux symptoms offset by more side effects.