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Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis

(2009) ARCHIVES OF SURGERY. 144(3). p.273-278
Author
Organization
Abstract
Objective: To perform a meta-analysis of randomized trials comparing partial fundoplication (PF) with total (Nissen) fundoplication (TF) for gastroesophageal reflux disease in terms of morbidity, efficacy, and long-term symptomatology. Data Sources: A structured Medline search for published studies. Study Selection: The available literature from 1975 until June 2007 was searched using the Medical Subject Headings of the National Library of Medicine term fundoplication and the free-text terms fundoplication, surgery, and reflux. Data were analyzed using Review Manager software (Cochrane Collaboration, Oxford, England). Data Extraction: Eleven trials were identified comparing TF with PF in 991 patients. Data Synthesis: Total fundoplication resulted in a significantly higher incidence of postoperative dysphagia (odds ratio [OR], 1.82-3.93; P<.001), bloating (OR, 1.07-2.56; P=.02), and flatulence (OR, 1.66-3.96; P<.001). No significant differences were noted in the incidence of esophagitis (OR, 0.72-2.7; P=.33), heartburn (OR, 0.48-1.52; P=.58), or persisting acid reflux (OR, 0.77-1.79; P=.45). The reoperation rate was significantly higher after TF compared with PF (OR, 1.13-3.95; P=.02). No significant differences were present in the proportion of patients experiencing a good or excellent long-term outcome (OR, 0.54-1.38; P=.53) or in the proportion of patients with a Visick I or II score (OR, 0.62-1.59; P=.99). Conclusions: Partial fundoplication is a safe and effective alternative to TF, resulting in significantly fewer reoperations and a better functional outcome. The poor quality of the included trials warrants caution in the interpretation of the results of this meta-analysis.
Keywords
SURGICAL-TREATMENT, BARRETT-ESOPHAGUS, ESOPHAGEAL MOTILITY, TOUPET FUNDOPLICATION, FOLLOW-UP, ANTIREFLUX SURGERY, DOUBLE-BLIND TRIAL, ANTERIOR PARTIAL FUNDOPLICATION, RANDOMIZED CLINICAL-TRIAL, LAPAROSCOPIC NISSEN FUNDOPLICATION

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Citation

Please use this url to cite or link to this publication:

MLA
Varin, Oswald et al. “Total Vs Partial Fundoplication in the Treatment of Gastroesophageal Reflux Disease: a Meta-analysis.” ARCHIVES OF SURGERY 144.3 (2009): 273–278. Print.
APA
Varin, O., Velstra, B., De Sutter, S., & Ceelen, W. (2009). Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis. ARCHIVES OF SURGERY, 144(3), 273–278.
Chicago author-date
Varin, Oswald, Berit Velstra, Stijn De Sutter, and Wim Ceelen. 2009. “Total Vs Partial Fundoplication in the Treatment of Gastroesophageal Reflux Disease: a Meta-analysis.” Archives of Surgery 144 (3): 273–278.
Chicago author-date (all authors)
Varin, Oswald, Berit Velstra, Stijn De Sutter, and Wim Ceelen. 2009. “Total Vs Partial Fundoplication in the Treatment of Gastroesophageal Reflux Disease: a Meta-analysis.” Archives of Surgery 144 (3): 273–278.
Vancouver
1.
Varin O, Velstra B, De Sutter S, Ceelen W. Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis. ARCHIVES OF SURGERY. 2009;144(3):273–8.
IEEE
[1]
O. Varin, B. Velstra, S. De Sutter, and W. Ceelen, “Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis,” ARCHIVES OF SURGERY, vol. 144, no. 3, pp. 273–278, 2009.
@article{832235,
  abstract     = {Objective: To perform a meta-analysis of randomized trials comparing partial fundoplication (PF) with total (Nissen) fundoplication (TF) for gastroesophageal reflux disease in terms of morbidity, efficacy, and long-term symptomatology.
Data Sources: A structured Medline search for published studies.
Study Selection: The available literature from 1975 until June 2007 was searched using the Medical Subject Headings of the National Library of Medicine term fundoplication and the free-text terms fundoplication, surgery, and reflux. Data were analyzed using Review Manager software (Cochrane Collaboration, Oxford, England).
Data Extraction: Eleven trials were identified comparing TF with PF in 991 patients.
Data Synthesis: Total fundoplication resulted in a significantly higher incidence of postoperative dysphagia (odds ratio [OR], 1.82-3.93; P<.001), bloating (OR, 1.07-2.56; P=.02), and flatulence (OR, 1.66-3.96; P<.001). No significant differences were noted in the incidence of esophagitis (OR, 0.72-2.7; P=.33), heartburn (OR, 0.48-1.52; P=.58), or persisting acid reflux (OR, 0.77-1.79; P=.45). The reoperation rate was significantly higher after TF compared with PF (OR, 1.13-3.95; P=.02). No significant differences were present in the proportion of patients experiencing a good or excellent long-term outcome (OR, 0.54-1.38; P=.53) or in the proportion of patients with a Visick I or II score (OR, 0.62-1.59; P=.99).
Conclusions: Partial fundoplication is a safe and effective alternative to TF, resulting in significantly fewer reoperations and a better functional outcome. The poor quality of the included trials warrants caution in the interpretation of the results of this meta-analysis.},
  author       = {Varin, Oswald and Velstra, Berit and De Sutter, Stijn and Ceelen, Wim},
  issn         = {0004-0010},
  journal      = {ARCHIVES OF SURGERY},
  keywords     = {SURGICAL-TREATMENT,BARRETT-ESOPHAGUS,ESOPHAGEAL MOTILITY,TOUPET FUNDOPLICATION,FOLLOW-UP,ANTIREFLUX SURGERY,DOUBLE-BLIND TRIAL,ANTERIOR PARTIAL FUNDOPLICATION,RANDOMIZED CLINICAL-TRIAL,LAPAROSCOPIC NISSEN FUNDOPLICATION},
  language     = {eng},
  number       = {3},
  pages        = {273--278},
  title        = {Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis},
  url          = {http://archsurg.ama-assn.org/cgi/content/abstract/144/3/273},
  volume       = {144},
  year         = {2009},
}

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