title: Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis of randomized trials comparing partial fundoplication (PF) with total (Nissen) fundoplication (TF) for gastroesophageal reflux disease in terms of morbidity, efficacy, and long-term symptomatology.
  
  
  METHODS
  A structured Medline search for published studies.
  
  
  METHODS
  The available literature from 1975 until June 2007 was searched using the Medical Subject Headings of the National Library of Medicine term fundoplication and the free-text terms fundoplication, surgery, and reflux. Data were analyzed using Review Manager software (Cochrane Collaboration, Oxford, England).
  
  
  METHODS
  Eleven trials were identified comparing TF with PF in 991 patients.
  
  
  RESULTS
  Total fundoplication resulted in a significantly higher incidence of postoperative dysphagia (odds ratio [OR], 1.82-3.93; P < .001), bloating (OR, 1.07-2.56; P = .02), and flatulence (OR, 1.66-3.96; P < .001). No significant differences were noted in the incidence of esophagitis (OR, 0.72-2.7; P = .33), heartburn (OR, 0.48-1.52; P = .58), or persisting acid reflux (OR, 0.77-1.79; P = .45). The reoperation rate was significantly higher after TF compared with PF (OR, 1.13-3.95; P = .02). No significant differences were present in the proportion of patients experiencing a good or excellent long-term outcome (OR, 0.54-1.38; P = .53) or in the proportion of patients with a Visick I or II score (OR, 0.62-1.59; P = .99).
  
  
  CONCLUSIONS
  Partial fundoplication is a safe and effective alternative to TF, resulting in significantly fewer reoperations and a better functional outcome. The poor quality of the included trials warrants caution in the interpretation of the results of this meta-analysis.
authors.affiliation: Department of Surgery, Ghent University Hospital 2K12 IC, De Pintelaan 185, B-9000 Ghent, Belgium. oswald.varin@ugent.be
authors.forename: Oswald
authors.initials: O
authors.lastname: Varin
authors.forename: Berit
authors.initials: B
authors.lastname: Velstra
authors.forename: Stijn
authors.initials: S
authors.lastname: De Sutter
authors.forename: Wim
authors.initials: W
authors.lastname: Ceelen
mesh_terms: D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome