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Laparoscopic nissen vs anterior 90º partial fundoplication for GERD

Laparoscopic anterior 90º partial fundoplication is followed by fewer adverse effects than laparoscopic Nissen fundoplication, and it achieves a higher rate of satisfaction with the overall outcome, finds a study in the most recent issue of Archives of Surgery.

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Laparoscopic anterior 90º partial fundoplication for gastroesophageal reflux is associated with a lower incidence of postoperative dysphagia and other adverse effects compared with laparoscopic Nissen fundoplication.

Dr Watson and colleagues from Australia conducted a multicenter, prospective, double-blind, randomized controlled trial at 9 university teaching hospitals in 6 major cities in Australia and New Zealand.

The research team included 112 patients with proven gastroesophageal reflux disease presenting for laparoscopic fundoplication.

The researchers randomly allocated the participants to undergo either a Nissen (52 patients) or an anterior 90º partial procedure (60 patients).

The research team excluded patients with esophageal motility disorders, patients requiring a concurrent abdominal procedure, and patients who had undergone previous antireflux surgery.

Postoperative dysphagia, and wind-related adverse effects were less common after a laparoscopic anterior 90º partial fundoplication
Archives of Surgery

The researchers carried out independent assessment of dysphagia, heartburn, and overall satisfaction 1, 3, and 6 months after surgery using multiple clinical grading systems.

In addition the team made objective measurements of esophageal manometric parameters, esophageal acid exposure, and endoscopic assessment.

The researchers found that postoperative dysphagia, and wind-related adverse effects were less common after a laparoscopic anterior 90º partial fundoplication.

In addition, they found that relief of heartburn was better following laparoscopic Nissen fundoplication.

Overall satisfaction was better after anterior 90º partial fundoplication.

The research group noted that lower esophageal sphincter pressure, acid exposure, and endoscopy findings were similar for both procedures.

Dr Watson concluded, "At the 6-month follow-up, laparoscopic anterior 90º partial fundoplication is followed by fewer adverse effects than laparoscopic Nissen fundoplication with full fundal mobilization, and it achieves a higher rate of satisfaction with the overall outcome."

"However, this is offset to some extent by a greater likelihood of recurrent gastroesophageal reflux symptoms."

Archives of Surgery; 2004: 139: 1160-67
17 November 2004

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