title: A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults.
abstract: BACKGROUND
  Laparoscopic Nissen fundoplication (LNF) is the most common surgical procedure for the surgical management of gastro-esophageal reflux disease (GERD). Laparoscopic Toupet fundoplication (LTF) has been reported to have a lower prevalence of postoperative complications yet still obtain a similar level of reflux control. We conducted a meta-analysis to confirm the value of LNF and LTF.
  
  
  METHODS
  PubMed, Medline, Embase, Cochrane Library and Springerlink were searched for randomized controlled trials (RCTs) comparing LNF and LTF. Data regarding the benefits and adverse results of two techniques were extracted and compared using a meta-analysis.
  
  
  RESULTS
  Eight eligible RCTs comparing LNF (n = 625) and LTF (n = 567) were identified. There were no significant differences between LNF and LTF with regard to hospitalization duration, perioperative complications, patient satisfaction, postoperative heartburn, regurgitation, postoperative DeMeester scores, or esophagites. A shorter operative time and higher postoperative lower esophageal sphincter pressure were associated with LNF. Prevalence of postoperative dysphagia, gas-bloating, inability to belch, dilatation for dysphagia and reoperation were higher after LNF, but subgroup analyses showed that differences with respect to dysphagia between LNF and LTF disappeared over time. Subgroup analyses did not support "tailored therapy" according to preoperative esophageal motility.
  
  
  CONCLUSIONS
  LNF and LTF have equivalently good control of GERD and result in a similar prevalence of patient satisfaction. Based on current evidence, it is not rational or advisable to abandon LNF when choosing a surgical procedure for GERD.
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Du
authors.affiliation: Department of Gastroesophageal Reflux Disease, the General Hospital of the PLA Rocket Force, Beijing, 100088, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Yan
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China. zhonggaowang194@sina.com.|Department of Gastroesophageal Reflux Disease, the General Hospital of the PLA Rocket Force, Beijing, 100088, China. zhonggaowang194@sina.com.
authors.forename: Zhonggao
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Gastroesophageal Reflux Disease, the General Hospital of the PLA Rocket Force, Beijing, 100088, China.
authors.forename: Jimin
authors.initials: J
authors.lastname: Wu
mesh_terms: D000328:Adult; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D061646:Operative Time; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011312:Pressure; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome
keywords: Gastro-esophageal reflux disease; Laparoscopic fundoplication; Meta-analysis; Nissen; Randomized controlled trials; Toupet