title: Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication: results of a randomized, controlled clinical trial.
abstract: OBJECTIVE
  The aim of the study was to compare the efficacy and mechanical consequences of 2 partial fundoplications performed laparoscopically under the framework of a randomized, controlled clinical trial.
  
  
  BACKGROUND
  Although laparoscopic total fundoplication procedures have proven their effectiveness in the control of gastroesophageal reflux, problems remain with the functional consequences after a supra-competent gastric cardia high-pressure zone. Partial fundoplications have been found to be associated with fewer mechanical side effects.
  
  
  METHODS
  During a 2-year period, 95 patients with gastroesophageal reflux disease were enrolled into a randomized, controlled single-institution clinical trial comparing a partial posterior (Toupét, n = 48) fundoplication and an anterior partial wrap (Watson, n = 47). All patients were assessed postoperatively at predefined time points, and the 12-month follow-up data are presented in terms of clinical results and 24-hour pH monitoring variables.
  
  
  RESULTS
  Both patient groups were strictly comparable at the time of randomization. All operations were completed laparoscopically, and no serious complications were encountered. During the first postoperative year, a difference regarding the control of reflux symptoms was observed in favor of the posterior fundoplication. Esophageal acid exposure (% time pH <4) was substantially reduced by both operations but to a significantly lower level after a Toupét compared with the Watson partial fundoplication (1.0 +/- 0.3 vs. 5.6 +/- 1.1 mean +/- SEM; p < 0.001). Postfundoplication symptoms were infrequently recorded with no difference between the groups.
  
  
  CONCLUSIONS
  When performing a laparoscopic partial fundoplication, the posterior modification (Toupét) offers advantages in terms of better reflux control compared with an anterior type (Watson).
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. cecilia.hagedorn@vgregion.se
authors.forename: Cecilia
authors.initials: C
authors.lastname: Hagedorn
authors.forename: Claes
authors.initials: C
authors.lastname: Jönson
authors.forename: Hans
authors.initials: H
authors.lastname: Lönroth
authors.forename: Magnus
authors.initials: M
authors.lastname: Ruth
authors.forename: Anders
authors.initials: A
authors.lastname: Thune
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
mesh_terms: D000328:Adult; D003196:Computer Graphics; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric