Evidence-based appraisal in laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease.
OBJECTIVE
To demonstrate the optimal surgical procedure for gastroesophageal reflux disease.


METHODS
The electronic databases of Medline, Elsevier, Springerlink and Embase over the last 16 years were searched. All clinical trials involved in the outcomes of laparoscopic Nissen fundoplication (LNF) and laparoscopic Toupet fundoplication (LTF) were identified. The data of assessment in benefits and adverse results of LNF and LTF were extracted and compared using meta-analysis.


RESULTS
We ultimately identified a total of 32 references reporting nine randomized controlled trials, eight prospective cohort trials and 15 retrospective trials. These studies reported a total of 6236 patients, of whom 4252 (68.18%) underwent LNF and 1984 (31.82%) underwent LTF. There were no differences between LNF and LTF in patients' satisfaction, perioperative complications, postoperative heartburn, reflux recurrence and re-operation. Both LNF and LTF enhanced the function of lower esophageal sphincter and improved esophagitis. The postoperative dysphagia, gas-bloating syndrome, inability to belch and the need for dilatation after LNF were more common than after LTF. Subgroup analyses showed that dysphagia after LNF and LTF was similar in patients with normal esophageal peristalsis (EP), but occurred more frequently in patients with weak EP after LNF than after LTF. Furthermore, patients with normal EP after LNF still had a higher risk of developing dysphagia than did patients with abnormal EP after LTF.


CONCLUSIONS
Compared with LNF, LTF offers equivalent symptom relief and reduces adverse results.
Shan
Cheng-Xiang
CX
Department of Minimally Invasive Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Zhang
Wei
W
Zheng
Xiang-Min
XM
Jiang
Dao-Zhen
DZ
Liu
Sheng
S
Qiu
Ming
M
D002986:Clinical Trials as Topic; D016208:Databases, Factual; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome