Document Detail

Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis.
MedLine Citation:
PMID:  19289668     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To perform a meta-analysis of randomized trials comparing partial fundoplication (PF) with total (Nissen) fundoplication (TF) for gastroesophageal reflux disease in terms of morbidity, efficacy, and long-term symptomatology. DATA SOURCES: A structured Medline search for published studies. STUDY SELECTION: The available literature from 1975 until June 2007 was searched using the Medical Subject Headings of the National Library of Medicine term fundoplication and the free-text terms fundoplication, surgery, and reflux. Data were analyzed using Review Manager software (Cochrane Collaboration, Oxford, England). DATA EXTRACTION: Eleven trials were identified comparing TF with PF in 991 patients. DATA SYNTHESIS: Total fundoplication resulted in a significantly higher incidence of postoperative dysphagia (odds ratio [OR], 1.82-3.93; P < .001), bloating (OR, 1.07-2.56; P = .02), and flatulence (OR, 1.66-3.96; P < .001). No significant differences were noted in the incidence of esophagitis (OR, 0.72-2.7; P = .33), heartburn (OR, 0.48-1.52; P = .58), or persisting acid reflux (OR, 0.77-1.79; P = .45). The reoperation rate was significantly higher after TF compared with PF (OR, 1.13-3.95; P = .02). No significant differences were present in the proportion of patients experiencing a good or excellent long-term outcome (OR, 0.54-1.38; P = .53) or in the proportion of patients with a Visick I or II score (OR, 0.62-1.59; P = .99). CONCLUSIONS: Partial fundoplication is a safe and effective alternative to TF, resulting in significantly fewer reoperations and a better functional outcome. The poor quality of the included trials warrants caution in the interpretation of the results of this meta-analysis.
Oswald Varin; Berit Velstra; Stijn De Sutter; Wim Ceelen
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  144     ISSN:  1538-3644     ISO Abbreviation:  Arch Surg     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-17     Completed Date:  2009-03-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  273-8     Citation Subset:  AIM; IM    
Department of Surgery, Ghent University Hospital 2K12 IC, De Pintelaan 185, B-9000 Ghent, Belgium.
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MeSH Terms
Fundoplication / adverse effects,  methods*
Gastroesophageal Reflux / surgery*
Randomized Controlled Trials as Topic
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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