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Systematic review and meta‐analysis of laparoscopic Nissen fundoplication with or without division of the short gastric vessels. BJS 2011; 98: 1056-1062.

Published: 10th May 2011

Authors: S. R. Markar, A. P. Karthikesalingam, O. J. Wagner, D. Jackson, J. C. Hewes, S. Vyas et al.

Background

The aim of this meta‐analysis was to provide a pooled analysis of individual trials comparing clinical outcome following laparoscopic Nissen fundoplication with or without division of the short gastric vessels (SGVs).

Method

Primary outcome measures were the requirement for reoperation, and the presence of postoperative gastro‐oesophageal reflux and postoperative dysphagia. Secondary outcome measures were duration of operation, length of hospital stay, postoperative complications (within 30 days of surgery), postoperative gas bloat syndrome, lower oesophageal sphincter resting pressure and DeMeester score. Pooled odds ratios were calculated for categorical outcomes, and weighted mean differences for secondary continuous outcomes, using random‐effects models for meta‐analysis.

Results

Five randomized trials were included in the analysis. There was no statistically significant effect on the requirement for reoperation, or presence of postoperative dysphagia or reflux. SGV division was associated with a longer duration of operation and a reduced postoperative lower oesophageal sphincter pressure. There was no statistically significant difference in length of hospital stay, postoperative complications, postoperative gas bloat syndrome or DeMeester score.

Conclusion

This meta‐analysis has demonstrated that clinical outcome following laparoscopic Nissen fundoplication appears to be similar regardless of whether the short gastric vessels are divided. However, it is not possible to exclude many potentially important clinical differences and further studies are needed. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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