Long-term follow-up of two randomized trials comparing laparoscopic Nissen 360° with anterior 90° partial fundoplication. Issue 1 (10th September 2019)

• Record Type: Journal Article
• Authors: Hopkins, R J; Irvine, T; Jamieson, G G; Devitt, P G; Watson, D I
• Is Part Of: British journal of surgery. Volume 107:Issue 1(2020)
• Page Start: 56
• Page End: 63
• Publication Date: 2019-09-10
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.11327
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: The side-effects of Nissen fundoplication have led to modifications, including partial fundoplications such as an anterior 90° wrap. Five-year follow-up of two randomized trials suggested fewer side-effects following anterior 90° partial fundoplication, but better reflux control after Nissen fundoplication. However, longer-term outcomes have not been reported. This study combined data from previous trials to determine 10-year outcomes. Methods: From 1999 to 2003, 191 patients were enrolled in two randomized trials comparing anterior 90° partial versus Nissen fundoplication. Trial protocols were similar, and data were combined to determine long-term clinical outcomes. Patients completed annual questionnaires assessing dysphagia, heartburn, medications, satisfaction and other symptoms. Visual analogue scales (0–10), a composite dysphagia score (0–45) and yes/no responses were used. Results: Of the 191 patients, 152 (79·6 per cent) were available for 10-year follow-up. After anterior 90° fundoplication, patients reported less dysphagia to solids (score 2·03 versus 3·18 for the Nissen procedure; P = 0·037). Heartburn scores were lower after Nissen fundoplication (1·90 versus 2·83 for anterior 90° fundoplication; P = 0·035) and fewer patients required proton pump inhibitors (PPIs) (22 versus 39 per cent respectively; P = 0·035). Satisfaction scores were similar for both anterior 90° and Nissen groups (7·45 versus 7·36 respectively; P = 0·566), and the majority considered their original decision for surgery to be correct (86 versus 84 per cent; P = 0·818). Conclusion: After 10 years, both procedures achieved similar success as measured by global satisfaction measures. Patients who had a Nissen fundoplication reported more dysphagia, whereas more heartburn and PPI consumption were reported after anterior 90° fundoplication. Registration numbers: ACTRN12607000298415 and ACTRN12607000304437 (http://www.anzctr.org.au/ ). Graphical Abstract: Outcomes at 10 years of follow-up from two randomized trials of anterior 90° partial fundoplication versus Nissen fundoplication were combined, and demonstrated that both fundoplication types achieve effective long-term symptom control, but with trade-offs between reflux control and side-effects. As different patients might prioritize these outcomes differently, the type of fundoplication can be tailored to each patient's aims and expectations. Comparable outcomes after a decade