title: Randomized controlled trial of laparoscopic anterior 180° partial versus posterior 270° partial fundoplication.
abstract: BACKGROUND
  Previous trials show good outcomes following anterior and posterior partial versus Nissen fundoplication for gastro-oesophageal reflux. However, it is unclear which partial fundoplication performs best. This study compared anterior 180° versus posterior 270° fundoplication.
  
  
  METHODS
  At three hospitals, patients were randomized to anterior 180° versus posterior 270° partial fundoplication, and clinical outcomes were determined using a structured questionnaire at 3, 6 and 12 months. Heartburn, dysphagia and satisfaction were assessed using 0-10 analoue scales, and adverse outcomes and side effects were determined. Endoscopy, manometry and pH monitoring were performed 6 months after surgery.
  
  
  RESULTS
  Forty-seven patients were randomized to anterior (n = 23) versus posterior (n = 24) fundoplication. Clinical outcomes for 93-98% of patients were available at each follow-up point. At 12 months, the mean heartburn score was higher following anterior fundoplication (2.7 versus 0.8, P = 0.045), although differences were not significant at earlier follow-up. Conversely, following posterior fundoplication, patients were less able to belch at 3 (56% versus 16%, P = 0.013) and 6 months (43% versus 9%, P = 0.017). No significant differences were demonstrated for dysphagia. Both groups had high rates of satisfaction with the outcome - 85% versus 86% satisfied at 12 months follow-up.
  
  
  CONCLUSIONS
  Both partial fundoplications are effective treatments for gastro-oesophageal reflux. Posterior partial fundoplication is associated with less reflux symptoms offset by more side effects.
authors.affiliation: Department of Surgery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Wan Najmi Wan
authors.initials: WN
authors.lastname: Daud
authors.affiliation: Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Thompson
authors.affiliation: Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Glyn G
authors.initials: GG
authors.lastname: Jamieson
authors.affiliation: Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Devitt
authors.affiliation: Department of Surgery, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Ian J G
authors.initials: IJ
authors.lastname: Martin
authors.affiliation: Department of Surgery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: David I
authors.initials: DI
authors.lastname: Watson
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: fundoplication; gastro-oesophageal reflux disease; laparoscopy; randomized controlled trial