title: Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? systematic review and meta-analysis.
abstract: BACKGROUND
  Although the high incidence of gastroesophageal reflux disease (GERD) in the population, there is much controversy in this topic, especially in the surgical treatment. The decision to use of a total or partial fundoplication in the treatment of GERD is still a challenge to many surgeons because the few evidence found in the literature.
  
  
  OBJECTIVE
  To bring more clear evidence in the comparison between total and partial fundoplication.
  
  
  METHODS
  A systematic review of the literature and metaanalysis with randomized controlled trials accessed from MEDLINE, LILACS, Cochrane Controlled Trials Database was done. The outcomes remarked were: dysphagia, inability to belch, bloating, recurrence of acid reflux, heartburn and esophagitis. For data analysis the odds ratio was used with corresponding 95% confidence interval. Statistical heterogeneity in the results of the metaanalysis was assessed by calculating a test of heterogeneity. The software Review Manager 5 (Cochrane Collaboration) was utilized for the data gathered and the statistical analysis. Sensitive analysis was applied using only trials that included follow-up over 2 years.
  
  
  RESULTS
  Ten trials were included with 1003 patients: 502 to total fundoplication group and 501 to partial fundoplication group. The outcomes dysphagia and inability to belch had statistical significant difference (P = 0.00001) in favor of partial fundoplication. There was not statistical difference in outcomes related with treatment failure. There were no heterogeneity in the outcomes dysphagia and recurrence of the acid reflux.
  
  
  CONCLUSIONS
  The partial fundoplication has lower incidence of obstructive side effects.
authors.affiliation: Departamento de Cirurgia, Universidade Federal Fluminense, Niterói, RJ, Brazil. rofelippe@terra.com.br
authors.forename: Rodrigo F
authors.initials: RF
authors.lastname: Ramos
authors.forename: Suzana Angélica S
authors.initials: SA
authors.lastname: Lustosa
authors.forename: Carlos Augusto P de
authors.initials: CA
authors.lastname: Almeida
authors.forename: Carolina P da
authors.initials: CP
authors.lastname: Silva
authors.forename: Delcio
authors.initials: D
authors.lastname: Matos
mesh_terms: D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome