title: One- and ten-year outcome of laparoscopic anterior 120° versus total fundoplication: a double-blind, randomized multicenter study.
abstract: BACKGROUND
  Nissen fundoplication is an effective treatment for gastroesophageal reflux disease (GERD) but can cause adverse effects like flatulence and dysphagia. The aim was to compare laparoscopic anterior 120° fundoplication (APF) to total fundoplication (Nissen) concerning flatulence and other adverse effects, in a randomized blinded study.
  
  
  METHODS
  Seventy-two patients were randomized to APF (n = 36) or Nissen (n = 36). Gastroscopy, 24-h pH monitoring and evaluation for symptoms and quality of life using questionnaires (GSRS, PGWB and 7-graded Likert scales) were performed preoperatively, at 1 and 10 years postoperatively. Patients and the researchers were blinded to operative method.
  
  
  RESULTS
  When entering the study, most patients had mild-moderate reflux disease according to the symptom score, the 24-h pH measurements, and frequency and grade of esophagitis. At 1-year (n = 68) flatulence, dysphagia, heartburn and acid regurgitation did not differ between groups. More patients could belch (p = 0.005), and pH monitoring showed a higher time with pH < 4 in the APF group (p = 0.006). At 10 years (n = 61), the APF group reported less dysphagia (p < 0.001), more heartburn (p = 0.019) and more patients could belch (p = 0.012) and vomit (p < 0.001) compared to the Nissen. No difference remained at 10 years in pH monitoring (n = 23) between groups. Symptoms of heartburn and acid regurgitation were less than preoperatively in both groups (p < 0.001). No revisional operations were performed.
  
  
  CONCLUSIONS
  Both procedures offer good long-term control of reflux symptom, with modest post-fundoplication symptoms. Anterior 120° fundoplication results in less dysphagia, better ability to belch and vomit than total fundoplication at 10-year follow-up. The results suggest that APF could be an alternative to Nissen fundoplication in the surgical treatment of mild-moderate GERD.
authors.affiliation: Department of Surgery, Skåne University Hospital, 221 85, Lund, Sweden. Pauline.Djerf@med.lu.se.|Clinical Sciences, Lund University, Lund, Sweden. Pauline.Djerf@med.lu.se.
authors.forename: Pauline
authors.initials: P
authors.lastname: Djerf
authors.affiliation: Department of Surgery, Skåne University Hospital, Malmö, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Montgomery
authors.affiliation: Department of Surgery, Norra Älvsborg County Hospital, Trollhättan, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Hallerbäck
authors.affiliation: Department of Surgery, Kalmar County Hospital, Kalmar, Sweden.
authors.forename: Hans-Olof
authors.initials: HO
authors.lastname: Håkansson
authors.affiliation: Department of Surgery, Skåne University Hospital, 221 85, Lund, Sweden.|Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Folke
authors.initials: F
authors.lastname: Johnsson
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004311:Double-Blind Method; D004884:Eructation; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006356:Heartburn / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D014839:Vomiting; D055815:Young Adult
keywords: Adverse effects; Fundoplication; Gastroesophageal reflux disease; Laparoscopic surgery; Long-term effects; Randomized controlled trial
references.citation: Scand J Gastroenterol Suppl. 1996;221:8-13
references.pmid: 9110389
references.citation: Scand J Gastroenterol. 1993 Aug;28(8):681-7
references.pmid: 8210982
references.citation: Ann Surg. 2013 Aug;258(2):233-9
references.pmid: 23207247
references.citation: Br J Surg. 1993 Jan;80(1):46-9
references.pmid: 8428292
references.citation: Scand J Gastroenterol. 2010;45(1):15-20
references.pmid: 19900054
references.citation: Gut. 1987 Sep;28(9):1145-50
references.pmid: 3315881
references.citation: Ann Surg. 2007 Aug;246(2):201-6
references.pmid: 17667497
references.citation: Ann Surg. 2012 Apr;255(4):637-42
references.pmid: 22418004
references.citation: World J Gastroenterol. 2013 Jun 28;19(24):3810-8
references.pmid: 23840119
references.citation: Br J Surg. 1995 May;82(5):651-6
references.pmid: 7613942
references.citation: Br J Surg. 1996 Jun;83(6):830-5
references.pmid: 8696754
references.citation: Dis Esophagus. 2012 Feb;25(2):114-20
references.pmid: 21883656
references.citation: J Gastrointest Surg. 2006 May;10(5):698-705
references.pmid: 16713542
references.citation: Br J Surg. 1998 Sep;85(9):1173-84
references.pmid: 9752855
references.citation: Br J Surg. 2008 Dec;95(12):1501-5
references.pmid: 18942055
references.citation: Br J Surg. 2005 Jul;92(7):819-23
references.pmid: 15898129
references.citation: Dig Surg. 2011;28(1):80-6
references.pmid: 21293136
references.citation: Ann Surg. 2009 Nov;250(5):698-706
references.pmid: 19801931
references.citation: Arch Surg. 2004 Nov;139(11):1160-7
references.pmid: 15545560
references.citation: Br J Surg. 1991 Sep;78(9):1088-94
references.pmid: 1933193
references.citation: Br J Surg. 1999 Jan;86(1):123-30
references.pmid: 10027375
references.citation: Ann Surg. 2013 May;257(5):850-9
references.pmid: 23470572
references.citation: Gut. 1999 Aug;45(2):172-80
references.pmid: 10403727