Randomized controlled trial of laparoscopic anterior 180° partial versus posterior 270° partial fundoplication

Wan Najmi Wan Daud, Sarah K Thompson, Glyn G Jamieson, Peter G Devitt, Ian J G Martin, David I Watson

    Research output: Contribution to journalArticlepeer-review

    8 Citations (Scopus)

    Abstract

    Background: Previous trials show good outcomes following anterior and posterior partial versus Nissen 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. ANZ Journal of Surgery.

    Original languageEnglish
    Pages (from-to)668-672
    Number of pages5
    JournalANZ Journal of Surgery
    Volume85
    Issue number9
    Early online date28 Nov 2013
    DOIs
    Publication statusPublished - 1 Sep 2015

    Keywords

    • Fundoplication
    • Gastro-oesophageal reflux disease
    • Laparoscopy
    • Randomized controlled trial

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