Total fundoplication for gastro-esophageal reflux disease may be followed by unwanted side-effects.
Dr Ludemann and colleagues undertook a randomized trial in order to demonstrate that an anterior 180° partial fundoplication achieved effective reflux control and was associated with fewer side-effects than total fundoplication.
This paper reports longer-term (5 year) outcomes from that trial.
Between December 1995 and June 1997, the researchers randomized 107 patients to undergo either laparoscopic total fundoplication or a laparoscopic anterior 180° fundoplication.
After 5 years, the research team was able to follow up 101 of 103 eligible patients (51 total, 50 anterior).
A single-blinded investigator interviewed each patient and each participant completed a standardized questionnaire.
| Dysphagia was worse at 5 years after total fundoplication|
|British Journal of Surgery|
The questionnaire focused on symptoms and overall satisfaction with the results of fundoplication.
The research team found that there were no significant differences between the 2 groups with regard to control of heartburn or patient satisfaction with the overall outcome.
The researchers noted that dysphagia, measured by a visual analogue score for solid food and a composite dysphagia score, was worse at 5 years after total fundoplication.
In addition, the researchers found that symptoms of bloating, inability to belch and flatulence were also more common after total fundoplication.
Reoperation was required for dysphagia in 3 patients after total fundoplication and for recurrent reflux in 3 patients after anterior fundoplication.
Dr Ludemann concluded, "Anterior 180° partial fundoplication was as effective as total fundoplication for managing the symptoms of gastro-esophageal reflux in the longer term."
It was associated with a lower incidence of side-effects, although this was offset by a slightly higher risk of recurrent reflux symptoms.