Prospective randomized trial of laparoscopic Nissen fundoplication versus maintenance proton pump inhibition in the treatment of gastro‐oesophageal reflux disease in patients aged under 65 years: preliminary results. BJS 1999; 86: 425-425.
Published: 2nd January 2003
Authors: B. Decadt, R. Lowndes, M. Rhodes
Laparoscopic Nissen fundoplication (LNF) was compared with maintenance proton pump inhibition (PPI) in patients with gastro‐oesophageal reflux disease (GORD).
Some 113 patients (60 men; median age 45 (range 25–64) years) presented between June 1997 and June 1998 with a history of GORD of at least 2 years' duration. After giving informed consent they were investigated by endoscopy, 24‐h pH and oesophageal manometry. Of 66 patients who completed the investigations, 57 had significant GORD; these were randomized, 29 to PPI and 28 to LNF.
Endoscopic findings were equivalent in the two groups: 75 per cent of the PPI group had a hiatus hernia compared with 78 per cent of the LNF group; 54 per cent of the PPI group had oesophagitis compared with 71 per cent in the LNF group. Twenty‐four‐hour pH monitoring revealed De Meester scores of 21 (range 7–92) in the PPI group compared with 20 (range 10–99) in the LNF group. Manometry revealed a median␣lower oesophageal sphincter pressure (LOSP) of 10 (range 0–30) mmHg in the PPI group compared with 7 (range 1–30) mmHg in the LNF group. At 3 months after start of therapy, 24‐h pH monitoring revealed a median De Meester score of 11 for both groups (PPI range 7–24, LNF range 9–39). Median LOSP was 15 mmHg in the PPI group compared with 17 mmHg in the LNF group.
Preliminary results suggest that LNF provides the same reduction in acid reflux as maintenance PPI in the short term. Further study of this group of patients will assess not only the physiological benefits of surgery versus maintenance PPI but also its impact on well being and relative costs of the two treatments. © 1999 British Journal of Surgery Society LtdFull text