Laparoscopic anterior versus posterior fundoplication for gastro-esophageal reflux disease: a meta-analysis and systematic review

Memon, Muhammed Ashraf, Subramanya, Manjunath S., Hossain, Md Belal, Yunus, Rossita Mohamad, Khan, Shahjahan and Memon, Breda (2014) Laparoscopic anterior versus posterior fundoplication for gastro-esophageal reflux disease: a meta-analysis and systematic review. World Journal of Surgery, 39 4: 981-996. doi:10.1007/s00268-014-2889-0


Author Memon, Muhammed Ashraf
Subramanya, Manjunath S.
Hossain, Md Belal
Yunus, Rossita Mohamad
Khan, Shahjahan
Memon, Breda
Title Laparoscopic anterior versus posterior fundoplication for gastro-esophageal reflux disease: a meta-analysis and systematic review
Journal name World Journal of Surgery   Check publisher's open access policy
ISSN 1432-2323
0364-2313
Publication date 2014-12-02
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1007/s00268-014-2889-0
Open Access Status
Volume 39
Issue 4
Start page 981
End page 996
Total pages 16
Place of publication New York NY United States
Publisher Springer New York
Collection year 2015
Language eng
Formatted abstract
Objectives

Although laparoscopic posterior fundoplication (LPF) i.e., Nissen or Toupet have the proven efficacy for controlling gastro-esophageal reflux surgically, there remain problems with postoperative dysphagia and gas bloat syndrome. To decrease some of these postoperative complications, laparoscopic anterior fundoplication (LAF) was introduced. The aim of this study was to conduct a meta-analysis and systematic review of randomized controlled trials (RCTs) to investigate the merits and drawbacks of LPF versus LAF for the treatment of gastro-esophageal reflux disease (GERD).

Data Sources, Study Selection, and Review Methods

A search of Medline, Embase, Science Citation Index, Current Contents, PubMed, ISI Web of Science, and the Cochrane Database identified all RCTs comparing different types of LPF and LAF published in the English Language between 1990 and 2013. The meta-analysis was prepared in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) statement. Data was extracted and analyzed on ten variables which include dysphagia score, heartburn rate, redo operative rate, operative time, overall complications, rate of conversion to open, Visick grading of satisfaction, overall satisfaction, length of hospital stay, and postoperative 24-h pH scores.

Data Synthesis

Nine trials totaling 840 patients (anterior = 425, posterior = 415) were analyzed. There was a significant reduction in the odds ratio for dysphagia in the LAF group compared to the LPF group. Conversely, significant reduction in the odds ratio for heartburn was observed for LPF compared to LAF. Comparable effects were noted for both groups for other variables which include redo surgery, operating time, overall complications, conversion rate, Visick’s grading, patients’ satisfaction, length of hospital stay, and postoperative 24-h pH scores.

Conclusions

Based on this meta-analysis, LPF compared to LAF is associated with significant reduction in heartburn at the expense of higher dysphagia rate on a short- and medium-term basis. We therefore conclude that LPF is a better alternative to LAF for controlling GERD symptoms.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 02 Dec 2014

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2015 Collection
School of Medicine Publications
 
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