title: Short- and long-term results of laparoscopic versus open anti-reflux surgery: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  There is an ongoing debate about whether laparoscopic anti-reflux surgery (LARS) or open anti-reflux surgery (OARS) is the better option for the surgical treatment of gastroesophageal reflux disease (GERD). This study was aimed to evaluate and compare the short- and long-term results of both surgical strategies by means of a systematic review and meta-analysis.
  
  
  METHODS
  A systematic search of electronic databases (PubMed, Embase, The Cochrane Library) for studies published from 1970 to 2013 was performed. All randomized controlled trials (RCTs) that compared LARS with OARS were included. We analyzed the outcomes of each type of surgery over short- and long-term periods.
  
  
  RESULTS
  Twelve studies met final inclusion criteria (total n = 1,067). A total of 510 patients underwent OARS and 557 had LARS. The pooled analyses showed, despite of longer operation time, the hospital stay and sick leave were significantly reduced in the LARS group. Significant reductions were also observed in complication rates for the LARS group in both short (odds ratio (OR) 0.31, 95 % CI 0.17 to 0.56) and long-term periods (OR 0.24, 95 % CI 0.07 to 0.80). Although complaints of reflux symptoms were more frequent among LARS patients in the short-term follow-up, LARS achieved better control of reflux symptoms in the long-term period (P < 0.05). Reoperation rate, patient's satisfaction, and 24-h pH monitoring were all comparable between the two groups (all P > 0.05).
  
  
  CONCLUSIONS
  LARS is an effective and safe alternative of OARS for the surgical treatment of GERD, which enables a faster convalescence, better control of long-term reflux symptoms, and with reduced risk of complications.
authors.affiliation: Department of General Surgery, Shandong University Qilu Hospital, No.107 of the west cultural road, Jinan, 250012, Shandong, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Qu
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.forename: Qing-si
authors.initials: QS
authors.lastname: He
mesh_terms: D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006356:Heartburn / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D057045:Laryngopharyngeal Reflux / Q000209:etiology; D007902:Length of Stay; D061646:Operative Time; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome