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Long‐term symptom control of gastro‐oesophageal reflux disease 12 years after laparoscopic Nissen or 180° anterior partial fundoplication in a randomized clinical trial. BJS 2017; 104: 852-856.

Published: 3rd February 2017

Authors: D. J. Roks, J. A. Broeders, R. J. Baigrie

Background

Laparoscopic 180° anterior fundoplication has been shown to achieve similar reflux control to Nissen fundoplication, with fewer side‐effects, up to 5 years. However, there is a paucity of long‐term follow‐up data on this technique and antireflux surgery in general. This study reports 12‐year outcomes of a double‐blind RCT comparing laparoscopic Nissen versus 180° laparoscopic anterior fundoplication for gastro‐oesophageal reflux disease (GORD).

Method

Patients with proven GORD were randomized to laparoscopic Nissen or 180° anterior fundoplication. The 12‐year outcome measures included reflux control, dysphagia, gas‐related symptoms and patient satisfaction. Measures included scores on a visual analogue scale, a validated Dakkak score for dysphagia and Visick scores.

Results

Of the initial 163 patients randomized (Nissen 84, anterior 79), 90 (55·2 per cent) completed 12‐year follow‐up (Nissen 52, anterior 38). There were no differences in heartburn, dysphagia, gas‐related symptoms, patient satisfaction or surgical reintervention rate. Use of acid‐suppressing drugs was less common after Nissen than after 180° anterior fundoplication: four of 52 (8 per cent) and 11 of 38 (29 per cent) respectively (P = 0·008). The proportion of patients with absent or only mild symptoms was slightly higher after Nissen fundoplication: 45 of 50 (90 per cent) versus 28 of 38 (74 per cent) (P = 0·044).

Conclusion

The two surgical procedures provided similar control of heartburn and post‐fundoplication symptoms, with similar patient satisfaction and reoperation rates on long‐term follow‐up.

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