title: Esophageal pH profile following laparoscopic total fundoplication compared to anterior fundoplication.
abstract: In Barrett's esophagus, total abolition of reflux may give maximum protection against the development of malignancy. To determine whether laparoscopic anterior fundoplication gives the same degree of antireflux control as a total fundoplication, we analyzed a prospectively followed cohort of patients from randomized controlled trials of laparoscopic antireflux surgery. There were 167 patients who returned for routine esophageal pH studies within 6 months of surgery (123 laparoscopic total fundoplications and 44 anterior fundoplications). There was no difference in percentage time pH <4 between fundoplication groups, but the total number of reflux episodes was significantly different (total fundoplication, four reflux events vs. partial fundoplication, six reflux events; p = 0.03). It is difficult to believe that this difference is either biologically or clinically important. In patients with a second esophageal pH study more than 5 years later, both the percentage time pH <4 (0.1% total fundoplication vs. 2.7% partial fundoplication; p = 0.004) and total number of reflux episodes (three total fundoplication vs. 24 partial fundoplication; p = 0.002) were significantly different. However, the postoperative esophageal acid exposure was within the normal range for both total and partial fundoplication, so whether the statistical difference is clinically important, remains a moot point.
authors.affiliation: Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, 5005, Australia.
authors.forename: Andrew S Y
authors.initials: AS
authors.lastname: Wong
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Myers
authors.forename: Glyn G
authors.initials: GG
authors.lastname: Jamieson
mesh_terms: D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005744:Gastric Acid / Q000378:metabolism*; D005764:Gastroesophageal Reflux / Q000378:metabolism* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome