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Meta-Analysis
. 2024 Sep;106(7):569-575.
doi: 10.1308/rcsann.2023.0046. Epub 2023 Oct 16.

Long-term efficacy of total versus posterior partial fundoplication in patients with gastro-oesophageal reflux disease: a systematic review and meta-analysis

D V Peristeri  1 , H Room  1 , D Tsironis  1 , G Vasilikostas  1 , A Wan  1
Affiliations
Meta-Analysis

Long-term efficacy of total versus posterior partial fundoplication in patients with gastro-oesophageal reflux disease: a systematic review and meta-analysis

D V Peristeri et al. Ann R Coll Surg Engl. 2024 Sep.

Abstract

Introduction: Laparoscopic fundoplication remains the standard treatment for patients with severe gastro-oesophageal reflux disease (GORD). Multiple randomised controlled trials (RCTs) have compared the two most commonly performed surgical techniques, total and posterior partial fundoplication (Nissen [NF] and Toupet [TF]), in terms of symptom control and treatment failure in patients without subsequent dysmotility disorders. We aimed to conduct a systematic review and meta-analysis of these two techniques with regard to the long-term effect on reflux control and associated dysphagia.

Methods: The MEDLINE®, Embase®, PubMed® and Cochrane Library databases were searched, and all the relevant published RCTs were shortlisted according to the inclusion criteria. The summated outcomes of long-term results relating to the recurrence of GORD and dysphagia were evaluated in a meta-analysis using RevMan software.

Results: Eight studies (all RCTs) on 1,545 patients undergoing NF or TF were eligible for inclusion in this meta-analysis. There were 799 patients in the NF group and 746 in the TF group. In the random effects model analysis, the incidence of long-term recurrence of GORD was not statistically different between the NF and TF cohorts (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.34-1.41, z=1.01, p=0.31). However, the incidence of long-term dysphagia was statistically lower in the TF group (OR: 2.92, 95% CI: 1.49-5.72, z=3.13, p=0.002) with low between-study heterogeneity (I2=0%).

Conclusions: The findings of this systematic review and meta-analysis on symptomatic GORD appear to be in favour of partial posterior fundoplication (TF) as the optimal treatment. It provides equivalent outcomes in reflux symptom control with a lower risk of postoperative dysphagia compared with total fundoplication (NF).

Keywords: Antireflux surgery; Gastro-oesophageal reflux disease; Long-term outcomes; Nissen; Posterior partial fundoplication; Total fundoplication; Toupet.

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Figures

Figure 1
Figure 1
Study selection
Figure 2
Figure 2
Forest plot comparing results for recurrence of gastro-oesophageal reflux disease
Figure 3
Figure 3
Forest plot comparing results for postoperative dysphagia
See this image and copyright information in PMC

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