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https://hdl.handle.net/2440/121410
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Type: | Journal article |
Title: | Long-term follow-up of two randomized trials comparing laparoscopic Nissen 360° with anterior 90° partial fundoplication |
Author: | Hopkins, R.J. Irvine, T. Jamieson, G.G. Devitt, P.G. Watson, D.I. |
Citation: | British Journal of Surgery, 2020; 107(1):56-63 |
Publisher: | BJS Society |
Issue Date: | 2020 |
ISSN: | 0007-1323 1365-2168 |
Statement of Responsibility: | R. J. Hopkins, T. Irvine, G. G. Jamieson, P. G. Devitt, D. I. Watson |
Abstract: | BACKGROUND:The side-effects of Nissen fundoplication have led to modifications, including partial fundoplications such as an anterior 90° wrap. Five-year follow-up of two randomized trials suggested fewer side-effects following anterior 90° partial fundoplication, but better reflux control after Nissen fundoplication. However, longer-term outcomes have not been reported. This study combined data from previous trials to determine 10-year outcomes. METHODS:From 1999 to 2003, 191 patients were enrolled in two randomized trials comparing anterior 90° partial versus Nissen fundoplication. Trial protocols were similar, and data were combined to determine long-term clinical outcomes. Patients completed annual questionnaires assessing dysphagia, heartburn, medications, satisfaction and other symptoms. Visual analogue scales (0-10), a composite dysphagia score (0-45) and yes/no responses were used. RESULTS:Of the 191 patients, 152 (79·6 per cent) were available for 10-year follow-up. After anterior 90° fundoplication, patients reported less dysphagia to solids (score 2·03 versus 3·18 for the Nissen procedure; P = 0·037). Heartburn scores were lower after Nissen fundoplication (1·90 versus 2·83 for anterior 90° fundoplication; P = 0·035) and fewer patients required proton pump inhibitors (PPIs) (22 versus 39 per cent respectively; P = 0·035). Satisfaction scores were similar for both anterior 90° and Nissen groups (7·45 versus 7·36 respectively; P = 0·566), and the majority considered their original decision for surgery to be correct (86 versus 84 per cent; P = 0·818). CONCLUSION:After 10 years, both procedures achieved similar success as measured by global satisfaction measures. Patients who had a Nissen fundoplication reported more dysphagia, whereas more heartburn and PPI consumption were reported after anterior 90° fundoplication. Registration numbers: ACTRN12607000298415 and ACTRN12607000304437 (http://www.anzctr.org.au/). |
Keywords: | Humans Gastroesophageal Reflux Postoperative Complications Laparoscopy Treatment Outcome Fundoplication Follow-Up Studies Adult Middle Aged Patient Satisfaction Female Male |
Description: | First published: 10 September 2019 |
Rights: | © 2019 BJS Society Ltd Published by John Wiley & Sons Ltd. |
DOI: | 10.1002/bjs.11327 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/157986 http://purl.org/au-research/grants/nhmrc/1022722 http://purl.org/au-research/grants/nhmrc/375111 |
Published version: | http://dx.doi.org/10.1002/bjs.11327 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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