title: Multicenter, prospective, double-blind, randomized trial of laparoscopic nissen vs anterior 90 degrees partial fundoplication.
abstract: OBJECTIVE
  Laparoscopic anterior 90 degrees partial fundoplication for gastroesophageal reflux is associated with a lower incidence of postoperative dysphagia and other adverse effects compared with laparoscopic Nissen fundoplication.
  
  
  METHODS
  A multicenter, prospective, double-blind, randomized controlled trial.
  
  
  METHODS
  Nine university teaching hospitals in 6 major cities in Australia and New Zealand.
  
  
  METHODS
  One hundred twelve patients with proven gastroesophageal reflux disease presenting for laparoscopic fundoplication were randomized to undergo either a Nissen (52 patients) or an anterior 90 degrees partial procedure (60 patients). Patients with esophageal motility disorders, patients requiring a concurrent abdominal procedure, and patients who had undergone previous antireflux surgery were excluded from this study.
  
  
  METHODS
  Laparoscopic Nissen fundoplication with division of the short gastric vessels or laparoscopic anterior 90 degrees partial fundoplication.
  
  
  METHODS
  Independent assessment of dysphagia, heartburn, and overall satisfaction 1, 3, and 6 months after surgery using multiple clinical grading systems. Objective measurement of esophageal manometric parameters, esophageal acid exposure, and endoscopic assessment.
  
  
  RESULTS
  Postoperative dysphagia, and wind-related adverse effects were less common after a laparoscopic anterior 90 degrees partial fundoplication. Relief of heartburn was better following laparoscopic Nissen fundoplication. Overall satisfaction was better after anterior 90 degrees partial fundoplication. Lower esophageal sphincter pressure, acid exposure, and endoscopy findings were similar for both procedures.
  
  
  CONCLUSIONS
  At the 6-month follow-up, laparoscopic anterior 90 degrees culine partial fundoplication is followed by fewer adverse effects than laparoscopic Nissen fundoplication with full fundal mobilization, and it achieves a higher rate of satisfaction with the overall outcome. However, this is offset to some extent by a greater likelihood of recurrent gastroesophageal reflux symptoms.
authors.affiliation: Department of Surgery,k Flinders University of South Australia, Adelaide, Australia. david.watson@flinders.edu.au
authors.forename: David I
authors.initials: DI
authors.lastname: Watson
authors.forename: Glyn G
authors.initials: GG
authors.lastname: Jamieson
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lally
authors.forename: Stephen
authors.initials: S
authors.lastname: Archer
authors.forename: Justin R
authors.initials: JR
authors.lastname: Bessell
authors.forename: Michael
authors.initials: M
authors.lastname: Booth
authors.forename: Richard
authors.initials: R
authors.lastname: Cade
authors.forename: Graham
authors.initials: G
authors.lastname: Cullingford
authors.forename: Peter G
authors.initials: PG
authors.lastname: Devitt
authors.forename: David R
authors.initials: DR
authors.lastname: Fletcher
authors.forename: James
authors.initials: J
authors.lastname: Hurley
authors.forename: George
authors.initials: G
authors.lastname: Kiroff
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Martin
authors.forename: Ian J G
authors.initials: IJ
authors.lastname: Martin
authors.forename: Leslie K
authors.initials: LK
authors.lastname: Nathanson
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000209:etiology; D003938:Diagnostic Techniques, Digestive System; D004311:Double-Blind Method; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006356:Heartburn / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome