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Long‐term follow‐up of two randomized trials comparing laparoscopic Nissen 360° with anterior 90° partial fundoplication.

Published: 10th September 2019

Authors: R. J. Hopkins, T. Irvine, G. G. Jamieson, P. G. Devitt, D. I. Watson

Background

The side‐effects of Nissen fundoplication have led to modifications, including partial fundoplications such as an anterior 90° wrap. Five‐year follow‐up of two randomized trials suggested fewer side‐effects following anterior 90° partial fundoplication, but better reflux control after Nissen fundoplication. However, longer‐term outcomes have not been reported. This study combined data from previous trials to determine 10‐year outcomes.

Method

From 1999 to 2003, 191 patients were enrolled in two randomized trials comparing anterior 90° partial versus Nissen fundoplication. Trial protocols were similar, and data were combined to determine long‐term clinical outcomes. Patients completed annual questionnaires assessing dysphagia, heartburn, medications, satisfaction and other symptoms. Visual analogue scales (0–10), a composite dysphagia score (0–45) and yes/no responses were used.

Results

Of the 191 patients, 152 (79·6 per cent) were available for 10‐year follow‐up. After anterior 90° fundoplication, patients reported less dysphagia to solids (score 2·03 versus 3·18 for the Nissen procedure; P = 0·037). Heartburn scores were lower after Nissen fundoplication (1·90 versus 2·83 for anterior 90° fundoplication; P = 0·035) and fewer patients required proton pump inhibitors (PPIs) (22 versus 39 per cent respectively; P = 0·035). Satisfaction scores were similar for both anterior 90° and Nissen groups (7·45 versus 7·36 respectively; P = 0·566), and the majority considered their original decision for surgery to be correct (86 versus 84 per cent; P = 0·818).

Conclusion

After 10 years, both procedures achieved similar success as measured by global satisfaction measures. Patients who had a Nissen fundoplication reported more dysphagia, whereas more heartburn and PPI consumption were reported after anterior 90° fundoplication. Registration numbers: ACTRN12607000298415 and ACTRN12607000304437 (http://www.anzctr.org.au/).

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