Long-term results of antireflux surgery indicate the need for a randomized clinical trial.
BACKGROUND
Well conducted, comparative trials of laparoscopic versus open antireflux surgery with an adequate patient enrollment are few and they do not demonstrate obvious advantages for the laparoscopic approach except for a marginal gain in shorter hospital stay. The aim of this study was to compare the effectiveness of laparoscopic and open procedures.


METHODS
Two unselected groups of 230 patients were identified through a register of all inpatient public care in Sweden. Outcomes of laparoscopic and open antireflux surgery were compared using a disease-specific questionnaire 4 years after operation.


RESULTS
Failure and dissatisfaction were significantly more common in the laparoscopy group than among patients having conventional open surgery. Treatment failure rates were 29.0 and 14.6 per cent respectively (P = 0.004). Dissatisfaction rates were 15.0 and 7.0 per cent respectively (P = 0.005). There was no other questionnaire item for which the proportion of failures differed significantly between the two groups.


CONCLUSIONS
This study does not support the presumption that laparoscopic antireflux surgery is to be preferred to the open procedure. It is strongly recommended that a randomized controlled trial be conducted.
Sandbu
R
R
Department of Surgery, Uppsala University, Uppsala, Sweden. rune.sandbu@zeta.telenordia.se
Khamis
H
H
Gustavsson
S
S
Haglund
U
U
D000367:Age Factors; D015992:Body Mass Index; D002921:Cicatrix; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D005414:Flatulence / Q000209:etiology; D005740:Gases; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
D005740:Gases