Randomized trial of laparoscopic nissen vs. anterior 180 degree partial fundoplication - late clinical outcomes at 15-20 years

Simple item page
dc.contributor.authorRudolph-Stringer, V.
dc.contributor.authorBright, T.
dc.contributor.authorIrvine, T.
dc.contributor.authorThompson, S.K.
dc.contributor.authorDevitt, P.G.
dc.contributor.authorGame, P.A.
dc.contributor.authorJamieson, G.G.
dc.contributor.authorWatson, D.I.
dc.date.issued2020
dc.description.abstractOBJECTIVE:To determine very late clinical outcomes at up to 20 years follow-up from a randomized controlled trial of Nissen vs. anterior 180-degree partial fundoplication. SUMMARY BACKGROUND DATA:Nissen fundoplication for gastroesophageal reflux can be followed by troublesome side effects. To address this, partial fundoplications have been proposed. Previously reports from a randomized controlled trial of Nissen vs. anterior 180-degree partial fundoplication at up to 10 years follow-up showed good outcomes for both procedures. METHODS:107 participants were randomized to Nissen vs. anterior 180-degree partial fundoplication. 15-20 year follow-up data was available for 79 (41 Nissen, 38 anterior). Outcome was assessed using a standardized questionnaire with 0-10 analogue scores and yes/no questions to determine reflux symptoms, side-effects and satisfaction with surgery. RESULTS:After anterior fundoplication heartburn (mean score 3.2 vs 1.4, p = 0.001) and proton pump inhibitor use (41.7% vs 17.1%, p = 0.023) were higher, offset by less dysphagia for solids (mean score 1.8 vs 3.3, p = 0.015), and better ability to belch (84.2% vs 65.9%, p = 0.030). Measures of overall outcome were similar for both groups (mean satisfaction score 8.4 vs 8.0, p = 0.444; 86.8% vs 90.2% satisfied with outcome). Six participants underwent revision following anterior fundoplication (Nissen conversion for reflux - 6), and 7 underwent revision following Nissen fundoplication (Nissen to partial fundoplication for dysphagia - 5; redo Nissen for reflux - 1; paraesophageal hernia -1). CONCLUSIONS:At 15-20 years follow-up Nissen and anterior 180-degree partial fundoplication achieved similar success, but with trade-offs between better reflux control vs. more side-effects after Nissen fundoplication.
dc.description.statementofresponsibilityVictoria Rudolph-Stringer, Tim Bright, Tanya Irvine, Sarah K. Thompson, Peter G. Devitt, Glyn G. Jamieson, David I. Watson ... et al.
dc.identifier.citationAnnals of Surgery, 2020; 275(1):39-44
dc.identifier.doi10.1097/sla.0000000000004643
dc.identifier.issn0003-4932
dc.identifier.issn1528-1140
dc.identifier.urihttps://hdl.handle.net/2440/134090
dc.language.isoen
dc.publisherLippincott, Williams & Wilkins
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1022722
dc.rights© 2021 Wolters Kluwer Health, Inc. All rights reserved.
dc.source.urihttps://doi.org/10.1097/sla.0000000000004643
dc.subjectFundoplication; gastro-esophageal reflux disease; laparoscopy; randomized controlled trial
dc.titleRandomized trial of laparoscopic nissen vs. anterior 180 degree partial fundoplication - late clinical outcomes at 15-20 years
dc.typeJournal article
pubs.publication-statusPublished

Files

Collections

Medicine publications