Meta-Analysis of Randomized Clinical Trials Comparing Open and Laparoscopic Anti-Reflux Surgery

Peters, Matthew James, Mukhtar, Athar, Yunus, Rossita Mohamad, Khan, Shahjahan, Pappalardo, Juanita, Memon, Breda and Memon, Muhammed Ashraf (2009) Meta-Analysis of Randomized Clinical Trials Comparing Open and Laparoscopic Anti-Reflux Surgery. American Journal of Gastroenterology, 104 6: 1548-1561. doi:10.1038/ajg.2009.176


Author Peters, Matthew James
Mukhtar, Athar
Yunus, Rossita Mohamad
Khan, Shahjahan
Pappalardo, Juanita
Memon, Breda
Memon, Muhammed Ashraf
Title Meta-Analysis of Randomized Clinical Trials Comparing Open and Laparoscopic Anti-Reflux Surgery
Journal name American Journal of Gastroenterology   Check publisher's open access policy
ISSN 0002-9270
1572-0241
Publication date 2009-06-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1038/ajg.2009.176
Volume 104
Issue 6
Start page 1548
End page 1561
Total pages 14
Place of publication New York, NY, United States
Publisher Nature Publishing Group
Language eng
Formatted abstract
OBJECTIVES:
The aim of this study was to conduct a meta-analysis of randomized evidence to determine the relative merits of laparoscopic anti-reflux surgery (LARS) and open anti-reflux surgery (OARS) for proven gastro-esophageal reflux disease (GERD).
METHODS:
A search of the Medline, Embase, Science Citation Index, Current Contents, and PubMed databases identified all randomized clinical trials that compared LARS and OARS and that were published in the English language between 1990 and 2007. A meta-analysis was carried out in accordance with the QUOROM (Quality of Reporting of Meta-Analyses) statement. The six outcome variables analyzed were operating time, hospital stay, return to normal activity, perioperative complications, treatment failure, and requirement for further surgery. Random-effects meta-analyses were carried out using odds ratios (ORs) and weighted mean differences (WMDs).
RESULTS:
Twelve trials were considered suitable for the meta-analysis. A total of 503 patients underwent OARS and 533 had LARS. For three of the six outcomes, the summary point estimates favored LARS over OARS. There was a significant reduction of 2.68 days in the duration of hospital stay for the LARS group compared with that for the OARS group (WMD: -2.68, 95% confidence interval (CI): -3.54 to -1.81; P<0.0001), a significant reduction of 7.75 days in return to normal activity for the LARS group compared with that for the OARS group (WMD: -7.75, 95% CI: -14.37 to -1.14; P=0.0216), and finally, there was a statistically significant reduction of 65% in the relative odds of complication rates for the LARS group compared with that for the OARS group (OR: 0.35, 95% CI: 0.16–0.75; P=0.0072). The duration of operating time was significantly longer (39.02 min) in the LARS group (WMD: 39.02, 95% CI: 17.99–60.05; P=0.0003). Treatment failure rates were comparable between the two groups (OR: 1.39, 95% CI: 0.71–2.72; P=0.3423). Despite this, the requirement for further surgery was significantly higher in the LARS group (OR: 1.79, 95% CI: 1.00–3.22; P=0.05).
CONCLUSIONS:
On the basis of this meta-analysis, the authors conclude that LARS is an effective and safe alternative to OARS for the treatment of proven GERD. LARS enables a faster convalescence and return to productive activity, with a reduced risk of complications and a similar treatment outcome, than an open approach. However, there is a significantly higher rate of re-operation (79%) in the LARS group.
Keyword Conventional Nissen Fundoplication
Gastroesophageal-Reflux Disease
Follow-Up
Bias
Heterogeneity
Dysphagia
Quality
Repair
Cost
Redo
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 69 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 79 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 01 Jul 2013, 21:55:21 EST by System User on behalf of Scholarly Communication and Digitisation Service