What is the Best Anti-Reflux Operation? All Fundoplications are Not Created Equal

This month’s issue of the World Journal of Surgery presents a meta-analysis and systemic review of laparoscopic anterior versus posterior fundoplication for gastro-esophageal reflux disease [1]. The authors’ aim was to answer the above (very important) question, which is asked of an upper gastrointestinal surgeon countless times by his/her patients. However, although the authors have prepared a comprehensive and thorough review, their study design has not answered this question. By not addressing the anatomical differences between varying degrees of fundoplication, misleading outcomes might have been generated that will not influence current surgical practice.