title: A Meta-Analysis of Randomized Controlled Trials to Compare Long-Term Outcomes of Nissen and Toupet Fundoplication for Gastroesophageal Reflux Disease.
abstract: OBJECTIVE
  In recent years, several studies with large sample sizes and recent follow-up data have been published comparing outcomes between laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication. It is now timely to be re-evaluated and synthesized long-term efficacy and adverse events of both total and partial posterior fundoplication.
  
  
  METHODS
  Electronic searches for RCTs comparing the outcome after laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication were performed in the databases of MEDLINE, EMBASE, and the Cochrane Center Register of Controlled Trials. The data of evaluation in positive and adverse results of laparoscopic Nissen fundoplication and laparoscopic Nissen fundoplication were extracted and compared using meta-analysis.
  
  
  RESULTS
  13 RCTs were ultimately identified involving 814 (52.05%) and 750 (47.95%) patients who underwent laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication, respectively. The operative time, perioperative complications, postoperative satisfaction, recurrence, and the rates of medication adoption or re-operation due to recurrence were not significantly different between two groups. The two types of fundoplication both reinforced the anti-reflux barrier and elevated the lower esophageal sphincter pressure. However, rates of adverse results involving dysphasia, gas-bloat syndrome, inability to belch and re-operation due to severe dysphasia were significantly higher after LNF. In the subgroup analysis of wrap length≤2 cm, laparoscopic Nissen fundoplication was associated with a significantly higher incidence of postoperative dysphagia. However, in the subgroup wrap length>2 cm, the difference was not statistically significant.
  
  
  CONCLUSIONS
  Laparoscopic Toupet fundoplication might be the better surgery approach for gastroesophageal reflux disease with a lower rate of postoperative adverse results and equal effectiveness as Laparoscopic Nissen fundoplication.
authors.affiliation: Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China.
authors.forename: Zhi-chao
authors.initials: ZC
authors.lastname: Tian
authors.affiliation: Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China.
authors.forename: Cheng-xiang
authors.initials: CX
authors.lastname: Shan
authors.affiliation: Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China.
authors.forename: Dao-zhen
authors.initials: DZ
authors.lastname: Jiang
authors.affiliation: Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China.
authors.forename: Ming
authors.initials: M
authors.lastname: Qiu
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D005260:Female; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011312:Pressure; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome