Dr Joris Broeders and colleagues evaluated 10 years outcome of a multicenter randomized controlled trial on laparoscopic and conventional Nissen fundoplication, with focus on effectiveness and re-operation rate.

 

Laparoscopic has replaced conventional Nissen fundoplication as surgical treatment for gastroesophageal reflux disease (GERD).

Decisions are based on equal short-term effectiveness and reduced morbidity, but confirmation by long-term level 1 evidence is lacking.

The team randomized 177 proton pump inhibitor-refractory GERD patients to undergo laparoscopic or conventional Nissen fundoplication between 1997 and 1999.

The research team described 10 years results of surgery on reflux symptoms, general health, proton pump inhibitor use, and reoperation rates.

High-resolution manometry, 24-hour pH-impedance monitoring and barium swallow were performed in symptomatic patients only.

The researchers found a total of 148 patients participated in this 10-year follow-up study. 

GERD symptoms were relieved in 92% and 91% after laparoscopic and conventional Nissen fundoplication, respectively.

Severity of heartburn and dysphagia were similar, but slightly more patients had relief of regurgitation after laparoscopic.

The percentage of patients using proton pump inhibitors slowly increased with time in both groups to 27% for laparoscopic, and 22% for conventional Nissen fundoplication.

The team found general health and quality of life improved similarly in both groups.

The percentage of patients who would have opted for surgery again was similar as well.

The researchers noted that twice as many patients underwent reoperation after conventional Nissen fundoplication compared with laparoscopic, including a higher number of incisional hernia corrections.

Mean interval between operation and reintervention was longer after CNF of the patients who were dependent on daily proton pump inhibitor therapy at 10 years.

 

The team observed that 7 patients had recurrent GERD on pH-impedance monitoring, 5 of them with some form of anatomic recurrence. 

A total of 13 of 20 patients did not have recurrent GERD. 

The researchers found that 14 patients had an abnormal high-resolution manometry.

Dr Broeders's team concluded, "Conventional Nissen fundoplication  carries a higher risk for surgical reintervention compared with laparoscopic, mainly due to incisional hernia corrections."

"The 10-year effectiveness of laparoscopic andconventional Nissen fundoplication  is comparable in terms of improvement of GERD symptoms, proton pump inhibitor  use, quality of life, and objective reflux control."

"Consequently, the long-term results from this trial lend level 1 support to the use of laparoscopic as the surgical procedure of choice for GERD."