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Assessing the efficacy and safety of laparoscopic antireflux procedures for the management of gastroesophageal reflux disease: a systematic review with network meta-analysis

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Abstract

Background

Despite the extensive literature on laparoscopic antireflux surgery, comparative evidence across different procedures is scarce. The aim of this study was to assess and rank the most efficacious and safe laparoscopic procedures for the management of gastroesophageal reflux disease.

Methods

Medline, Embase, AMED, CINAHL, CENTRAL, and OpenGrey databases were queried for randomized trials comparing two or more laparoscopic antireflux procedures with each other or with medical treatment for the management of gastroesophageal reflux disease. Pairwise meta-analyses were conducted for each pair of interventions using a random-effects model. Network meta-analysis was employed to assess the relative efficacy and safety of laparoscopic antireflux procedures for the management of gastroesophageal reflux disease.

Results

Forty-four publications reporting 29 randomized trials which included 1892 patients were identified. The network of treatments was sparse with only a closed loop between different types of wraps; 270°, 360°, anterior 180° and anterior 90°; and star network between 360° and other treatments; and between anterior 180° and other treatments. Laparoscopic 270° (odds ratio, OR 1.19, 95% confidence interval, CI 0.64–2.22), anterior 180°, and anterior 90° were equally effective as 360° for control of heartburn, although this finding was supported by low quality of evidence according to GRADE modification for NMA. The odds for dysphagia were lower after 270° (OR 0.38, 95%, CI 0.24–0.60), anterior 90° (moderate quality evidence), and anterior 180° (low-quality evidence) compared to 360°. The odds for gas-bloat were lower after 270° (OR 0.51, 95% CI 0.27, 0.95) and after anterior 90° compared to 360° (low-quality evidence). Regurgitation, morbidity, and reoperation were similar across treatments, albeit these were associated with very low-quality evidence.

Conclusion

Laparoscopic 270° fundoplication achieves a better outcome than 360° total fundoplication, especially in terms of postoperative dysphagia, although other types of partial fundoplication might be equally effective.

Registration no.

CRD42017074783.

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References

  1. El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. https://doi.org/10.1136/gutjnl-2012-304269

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gisbert JP, Cooper A, Karagiannis D et al (2009) Impact of gastroesophageal reflux disease on patients’ daily lives: a European observational study in the primary care setting. Health Qual Life Outcomes. https://doi.org/10.1186/1477-7525-7-60

    Article  PubMed  PubMed Central  Google Scholar 

  3. Vela MF (2014) Medical treatments of GERD. The old and new. Gastroenterol Clin North Am 43:121–133. https://doi.org/10.1016/j.gtc.2013.12.001

    Article  PubMed  Google Scholar 

  4. Minjarez RC, Blair JA (2006) Surgical therapy for gastroesophageal reflux disease. GI Motil Online. https://doi.org/10.1038/gimo56

    Article  Google Scholar 

  5. Richter J (2013) Gastroesophageal reflux disease treatment: side effects and complications of fundoplication. Clin Gastroenterol Hepatol 11(5):465–471

    Article  Google Scholar 

  6. Broeders JA, Roks DJ, Ali UA et al (2013) Laparoscopic anterior 180-degree versus Nissen fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Ann Surg. https://doi.org/10.1097/SLA.0b013e31828604dd

    Article  PubMed  Google Scholar 

  7. Broeders JA, Roks DJ, Ahmed Ali U, Draaisma WA, Smout AJ, Hazebroek EJ (2011) Laparoscopic anterior versus posterior fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Ann Surg. https://doi.org/10.1097/SLA.0b013e31821d4ba0

    Article  PubMed  Google Scholar 

  8. Broeders JAJL, Mauritz FA, Ali UA et al (2010) Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg. https://doi.org/10.1002/bjs.7174

    Article  PubMed  Google Scholar 

  9. Antoniou SA, Koelemay M, Antoniou GA, Mavridis D (2018) A practical guide for application of network meta-analysis in evidence synthesis. Eur J Vasc Endovasc Surg. https://doi.org/10.1016/j.ejvs.2018.10.023

    Article  PubMed  Google Scholar 

  10. Nikolakopoulou A, Mavridis D, Furukawa TA et al (2018) Living network meta-analysis compared with pairwise meta-analysis in comparative effectiveness research: empirical study. BMJ 360:k585. https://doi.org/10.1136/bmj.k585

    Article  PubMed  PubMed Central  Google Scholar 

  11. Salanti G (2012) Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res Synth Methods. 3(2):80–97. https://doi.org/10.1002/jrsm.1037

    Article  PubMed  Google Scholar 

  12. Mavridis D, Giannatsi M, Cipriani A, Salanti G (2015) A primer on network meta-analysis with emphasis on mental health. Evid Based Ment Health. https://doi.org/10.1136/eb-2015-102088

    Article  PubMed  Google Scholar 

  13. Amer MA, Smith MD, Khoo CH, Herbison GP, McCall JL (2018) Network meta-analysis of surgical management of gastro-oesophageal reflux disease in adults. Br J Surg 105(11):1398–1407. https://doi.org/10.1002/bjs.10924

    Article  CAS  PubMed  Google Scholar 

  14. Hutton B, Salanti G, Caldwell DM et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. https://doi.org/10.7326/M14-2385

    Article  PubMed  Google Scholar 

  15. PlotDigitizer (2001)

  16. Cochrane TC (2008) Review Manager (RevMan) 5.3. Copenhagen Nord Cochrane Cent

  17. White I (2015) Network meta-analysis. Stata J. 15(4):951–985

    Article  Google Scholar 

  18. Using Stata for Standard Pairwise and Network Meta-Analysis. http://www.mtm.uoi.gr/index.php/stata-routines-for-network-meta-analysis

  19. Chaimani A, Higgins JPT, Mavridis D, Spyridonos P, Salanti G (2013) Graphical tools for network meta-analysis in STATA. PLoS ONE. https://doi.org/10.1371/journal.pone.0076654

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bucher HC, Guyatt GH, Griffith LE, Walter SD (1997) The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol. https://doi.org/10.1016/S0895-4356(97)00049-8

    Article  PubMed  Google Scholar 

  21. Dias S, Welton NJ, Caldwell DM, Ades AE (2010) Checking consistency in mixed treatment comparison meta-analysis. Stat Med. https://doi.org/10.1002/sim.3767

    Article  PubMed  Google Scholar 

  22. Higgins JPT, Jackson D, Barrett JK, Lu G, Ades AE, White IR (2012) Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods. https://doi.org/10.1002/jrsm.1044

    Article  PubMed  PubMed Central  Google Scholar 

  23. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol. https://doi.org/10.1016/j.jclinepi.2007.11.010

    Article  PubMed  Google Scholar 

  24. Mavridis D, Salanti G (2014) How to assess publication bias: funnel plot, trim-and-fill method and selection models. Evid Based Ment Heal. 17(1):30. https://doi.org/10.1136/eb-2013-101699

    Article  Google Scholar 

  25. Salanti G, Ades AE, Ioannidis JPA (2011) Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. https://doi.org/10.1016/j.jclinepi.2010.03.016

    Article  PubMed  Google Scholar 

  26. Salanti G, Del Giovane C, Chaimani A, Caldwell DM, Higgins JPT (2014) Evaluating the quality of evidence from a network meta-analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0099682

    Article  PubMed  PubMed Central  Google Scholar 

  27. CINeMA: Confidence in Network Meta-Analysis [Software] (2017) cinema.ispm.ch

  28. Roks DJ, Koetje JH, Oor JE, Broeders JA, Nieuwenhuijs VB, Hazebroek EJ (2017) Randomized clinical trial of 270° posterior versus 180° anterior partial laparoscopic fundoplication for gastro-oesophageal reflux disease. Br J Surg. https://doi.org/10.1002/bjs.10500

    Article  PubMed  Google Scholar 

  29. Roks DJ, Broeders JA, Baigrie RJ (2017) Long-term symptom control of gastro-oesophageal reflux disease 12 years after laparoscopic Nissen or 180° anterior partial fundoplication in a randomized clinical trial. Br J Surg. https://doi.org/10.1002/bjs.10473

    Article  PubMed  Google Scholar 

  30. Cai W, Watson DI, Lally CJ, Devitt PG, Game PA, Jamieson GG (2008) Ten-year clinical outcome of a prospective randomized clinical trial of laparoscopic Nissen versus anterior 180° partial fundoplication. Br J Surg. https://doi.org/10.1002/bjs.6318

    Article  PubMed  Google Scholar 

  31. Lundell L, Attwood S, Ell C et al (2008) Comparing laparoscopic antireflux surgery with esomeprazole in the management of patients with chronic gastro-oesophageal reflux disease: a 3-year interim analysis of the LOTUS trial. Gut. https://doi.org/10.1136/gut.2008.148833

    Article  PubMed  PubMed Central  Google Scholar 

  32. Mickevičius A, Endzinas Ž, Kiudelis M et al (2013) Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study. Surg Endosc. https://doi.org/10.1007/s00464-012-2550-7

    Article  PubMed  Google Scholar 

  33. Booth MI, Stratford J, Jones L, Dehn TCB (2008) Randomized clinical trial of laparoscopic total (Nissen) versus posterior partial (Toupet) fundoplication for gastro-oesophageal reflux disease based on preoperative oesophageal manometry. Br J Surg. https://doi.org/10.1002/bjs.6047

    Article  PubMed  Google Scholar 

  34. Watson DI, Jamieson GG, Pike GK, Davies N, Richardson M, Devitt PG (1999) Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg. https://doi.org/10.1046/j.1365-2168.1999.00969.x

    Article  PubMed  Google Scholar 

  35. Strate U, Emmermann A, Fibbe C, Layer P, Zornig C (2008) Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc Other Interv Tech. https://doi.org/10.1007/s00464-007-9546-8

    Article  Google Scholar 

  36. Guérin E, Bétroune K, Closset J et al (2007) Nissen versus Toupet fundoplication: results of a randomized and multicenter trial. Surg Endosc 21(11):1985–1990. https://doi.org/10.1007/s00464-007-9474-7

    Article  PubMed  Google Scholar 

  37. Wang B, Zhang W, Liu S, Du Z, Shan C, Qiu M (2015) A Chinese randomized prospective trial of floppy Nissen and Toupet fundoplication for gastroesophageal disease. Int J Surg. https://doi.org/10.1016/j.ijsu.2015.08.074

    Article  PubMed  Google Scholar 

  38. Engström C, Lönroth H, Mardani J, Lundell L (2007) An anterior or posterior approach to partial fundoplication? Long-term results of a randomized trial. World J Surg. https://doi.org/10.1007/s00268-007-9004-8

    Article  PubMed  Google Scholar 

  39. Laws HL, Clements RH, Swillie CM (1997) A randomized, prospective comparison of the nissen fundoplication versus the toupet fundoplication for gastroesophageal reflux disease. Ann Surg. https://doi.org/10.1097/00000658-199706000-00002

    Article  PubMed  PubMed Central  Google Scholar 

  40. Anvari M, Allen C, Marshall J et al (2006) A randomized controlled trial of laparoscopic nissen fundoplication versus proton pump inhibitors for treatment of patients with chronic gastroesophageal reflux disease: one-year follow-up. Surg Innov. 13(4):238–249. https://doi.org/10.1177/1553350606296389

    Article  PubMed  Google Scholar 

  41. Djerf P, Montgomery A, Hallerbäck B, Håkansson H-O, Johnsson F (2016) One- and ten-year outcome of laparoscopic anterior 120° versus total fundoplication: a double-blind, randomized multicenter study. Surg Endosc. https://doi.org/10.1007/s00464-015-4177-y

    Article  PubMed  Google Scholar 

  42. Mehta S, Bennett J, Mahon D, Rhodes M (2006) Prospective trial of laparoscopic nissen fundoplication versus proton pump inhibitor therapy for gastroesophageal reflux disease: seven-year follow-up. J Gastrointest Surg. https://doi.org/10.1016/j.gassur.2006.07.010

    Article  PubMed  Google Scholar 

  43. Woodcock SA, Watson DI, Lally C et al (2006) Quality of life following laparoscopic anterior 90° versus Nissen fundoplication: results from a multicenter randomized trial. World J Surg. https://doi.org/10.1007/s00268-005-0623-7

    Article  PubMed  Google Scholar 

  44. Spence GM, Watson DI, Jamiesion GG, Lally CJ, Devitt PG (2006) Single center prospective randomized trial of laparoscopic nissen versus anterior 90° fundoplication. J Gastrointest Surg. https://doi.org/10.1016/j.gassur.2005.10.003

    Article  PubMed  Google Scholar 

  45. Mahon D, Rhodes M, Decadt B et al (2005) Randomized clinical trial of laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux. Br J Surg. https://doi.org/10.1002/bjs.4934

    Article  PubMed  Google Scholar 

  46. Baigrie RJ, Cullis SNR, Ndhluni AJ, Cariem A (2005) Randomized double-blind trial of laparoscopic Nissen fundoplication versus anterior partial fundoplication. Br J Surg 92(7):819–823. https://doi.org/10.1002/bjs.4803

    Article  CAS  PubMed  Google Scholar 

  47. Cookson R, Flood C, Koo B, Mahon D, Rhodes M (2005) Short-term cost effectiveness and long-term cost analysis comparing laparoscopic Nissen fundoplication with proton-pump inhibitor maintenance for gastro-oesophageal reflux disease. Br J Surg 92(6):700–706. https://doi.org/10.1002/bjs.4933

    Article  CAS  PubMed  Google Scholar 

  48. Ludemann R, Watson DI, Jamieson GG, Game PA, Devitt PG (2005) Five-year follow-up of a randomized clinical trial of laparoscopic total versus anterior 180° fundoplication. Br J Surg. https://doi.org/10.1002/bjs.4762

    Article  PubMed  Google Scholar 

  49. Watson DI, Jamieson GG, Lally C et al (2004) Multicenter, prospective, double-blind, randomized trial of laparoscopic nissen vs anterior 90° partial fundoplication. Arch Surg. https://doi.org/10.1001/archsurg.139.11.1160

    Article  PubMed  Google Scholar 

  50. Daud WNW, Thompson SK, Jamieson GG, Devitt PG, Martin IJG, Watson DI (2015) Randomized controlled trial of laparoscopic anterior 180° partial versus posterior 270° partial fundoplication. ANZ J Surg. https://doi.org/10.1111/ans.12476

    Article  PubMed  Google Scholar 

  51. Chrysos E, Athanasakis E, Pechlivanides G, Tzortzinis A, Mantides A, Xynos E (2004) The effect of total and anterior partial fundoplication on antireflux mechanisms of the gastroesophageal junction. Am J Surg. https://doi.org/10.1016/j.amjsurg.2003.10.023

    Article  PubMed  Google Scholar 

  52. Qin M, Ding G, Yang H (2013) A clinical comparison of laparoscopic Nissen and Toupet fundoplication for gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2012.0485

    Article  PubMed  Google Scholar 

  53. Hagedorn C, Jönson C, Lönroth H, Ruth M, Thune A, Lundell L (2003) Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication: results of a randomized, Controlled clinical trial. Ann Surg. https://doi.org/10.1097/00000658-200308000-00006

    Article  PubMed  PubMed Central  Google Scholar 

  54. Koch OO, Kaindlstorfer A, Antoniou SA, Luketina RR, Emmanuel K, Pointner R (2013) Comparison of results from a randomized trial 1 year after laparoscopic Nissen and Toupet fundoplications. Surg Endosc Other Interv Tech. 27(7):2383–2390. https://doi.org/10.1007/s00464-013-2803-0

    Article  Google Scholar 

  55. Chrysos E, Tsiaoussis J, Zoras OJ et al (2003) Laparoscopic surgery for gastroesophageal reflux disease patients with impaired esophageal peristalsis: total or partial fundoplication. J Am Coll Surg. https://doi.org/10.1016/S1072-7515(03)00151-0

    Article  PubMed  Google Scholar 

  56. Broeders JA, Broeders EA, Watson DI, Devitt PG, Holloway RH, Jamieson GG (2013) Objective outcomes 14 years after laparoscopic anterior 180-degree partial versus nissen fundoplication: results from a randomized trial. Ann Surg. https://doi.org/10.1097/SLA.0b013e318278960e

    Article  PubMed  Google Scholar 

  57. Mickevičius A, Endzinas Ž, Kiudelis M et al (2008) Influence of wrap length on the effectiveness of Nissen and Toupet fundoplication: a prospective randomized study. Surg Endosc 22(10):2269–2276. https://doi.org/10.1007/s00464-008-9852-9

    Article  PubMed  Google Scholar 

  58. Aye RW, Swanstrom LL, Kapur S et al (2012) A randomized multiinstitution comparison of the laparoscopic Nissen and Hill repairs. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2012.04.083

    Article  PubMed  Google Scholar 

  59. Watson DI, Devitt PG, Smith L, Jamieson GG (2012) Anterior 90° partial vs Nissen fundoplication-5 year follow-up of a single-centre randomised trial. J Gastrointest Surg. https://doi.org/10.1007/s11605-012-1920-8

    Article  PubMed  Google Scholar 

  60. Zornig C, Strate U, Fibbe C, Emmermann A, Layer P (2002) Nissen vs Toupet laparoscopic fundoplication. Surg Endosc 16(5):758–766. https://doi.org/10.1007/s00464-001-9092-8

    Article  CAS  PubMed  Google Scholar 

  61. Cao Z, Cai W, Qin M, Zhao H, Yue P, Li Y (2012) Randomized clinical trial of laparoscopic anterior 180° partial versus 360° Nissen fundoplication: 5-year results. Dis Esophagus. https://doi.org/10.1111/j.1442-2050.2011.01235.x

    Article  PubMed  Google Scholar 

  62. Fibbe C, Layer P, Keller J, Strate U, Emmermann A, Zornig C (2001) Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study. Gastroenterology 121(1):5–14. https://doi.org/10.1053/gast.2001.25486

    Article  CAS  PubMed  Google Scholar 

  63. Anvari M, Allen C, Marshall J et al (2011) A randomized controlled trial of laparoscopic Nissen fundoplication versus proton pump inhibitors for the treatment of patients with chronic gastroesophageal reflux disease (GERD): 3-year outcomes. Surg Endosc 25(8):2547–2554. https://doi.org/10.1007/s00464-011-1585-5

    Article  PubMed  Google Scholar 

  64. Goeree R, Hopkins R, Marshall JK et al (2011) Cost-utility of laparoscopic Nissen fundoplication versus proton pump inhibitors for chronic and controlled gastroesophageal reflux disease: a 3-year prospective randomized controlled trial and economic evaluation. Value Health 14(2):263–273. https://doi.org/10.1016/j.jval.2010.09.004

    Article  PubMed  Google Scholar 

  65. Raue W, Ordemann J, Jacobi CA, Menenakos C, Buchholz A, Hartmann J (2011) Nissen versus dor fundoplication for treatment of gastroesophageal reflux disease: a blinded randomized clinical trial. Dig Surg. 28(1):80–86. https://doi.org/10.1159/000323630

    Article  CAS  PubMed  Google Scholar 

  66. Khan M, Smythe A, Globe J, Stoddard CJ, Ackroyd R (2010) Randomized controlled trial of laparoscopic anterior versus posterior fundoplication for gastro-oesophageal reflux disease. ANZ J Surg 80(7–8):500–505. https://doi.org/10.1111/j.1445-2197.2009.05197.x

    Article  PubMed  Google Scholar 

  67. Nijjar RS, Watson DI, Jamieson GG et al (2010) Five-year follow-up of a multicenter, double-blind randomized clinical trial of laparoscopic Nissen vs anterior 90° partial fundoplication. Arch Surg. https://doi.org/10.1001/archsurg.2010.81

    Article  PubMed  Google Scholar 

  68. Shaw JM, Bornman PC, Callanan MD, Beckingham IJ, Metz DC (2010) Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial. Surg Endosc 24(4):924–932. https://doi.org/10.1007/s00464-009-0700-3

    Article  PubMed  Google Scholar 

  69. Khan MA, Smythe A, Globe J, Stoddard CJ, Ackroyd R (2009) Randomized controlled trial of laparoscopic Nissen versus Lind fundoplication for gastro-oesophageal reflux disease. Scand J Gastroenterol 44(3):269–275. https://doi.org/10.1080/00365520802495552

    Article  PubMed  Google Scholar 

  70. Koch OO, Antoniou SA, Kaindlstorfer A, Asche KU, Granderath FA, Pointner R (2012) Effectiveness of laparoscopic total and partial fundoplication on extraesophageal manifestations of gastroesophageal reflux disease: a randomized study. Surg Laparosc Endosc Percutaneous Tech. 22(5):387–391. https://doi.org/10.1097/sle.0b013e31825efb5b

    Article  Google Scholar 

  71. Koch OO, Kaindlstorfer A, Antoniou SA, Asche KU, Granderath FA, Pointner R (2012) Laparoscopic Nissen versus Toupet fundoplication: objective and subjective results of a prospective randomized trial. Surg Endosc Other Interv Tech. 26(2):413–422. https://doi.org/10.1007/s00464-011-1889-5

    Article  Google Scholar 

  72. Fuchs KH, Babic B, Breithaupt W et al (2014) EAES recommendations for the management of gastroesophageal reflux disease. Surg Endosc. https://doi.org/10.1007/s00464-014-3431-z

    Article  PubMed  Google Scholar 

  73. Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD (2010) Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 24(11):2647–2669. https://doi.org/10.1007/s00464-010-1267-8

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was methodologically supported by the European Association for Endoscopic Surgery Research Committee.

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Authors and Affiliations

  1. Upper GI Department, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, UK

    Alexandros Andreou

  2. Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, Australia

    David I. Watson

  3. Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece

    Dimitrios Mavridis

  4. Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France

    Dimitrios Mavridis

  5. Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK

    Nader K. Francis

  6. Department of Surgery, European University Cyprus, Nicosia, Cyprus

    Stavros A. Antoniou

  7. Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus

    Stavros A. Antoniou

  8. Athens, Greece

    Stavros A. Antoniou

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  1. Alexandros Andreou
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Correspondence to Stavros A. Antoniou.

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Disclosures

Prof. David I. Watson received funding support for RCTs included in this meta-analysis in the form of Research Project Grants from the National Health and Medical Research Council (NHMRC) of Australia - Grant nos. 375111 and 1022722. Mr Alexandros Andreou, Prof. Dimitrios Mavridis, Prof. Nader K. Francis, and Dr. Stavros A. Antoniou do not have any conflicts of interest or financial ties to disclose.

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Andreou, A., Watson, D.I., Mavridis, D. et al. Assessing the efficacy and safety of laparoscopic antireflux procedures for the management of gastroesophageal reflux disease: a systematic review with network meta-analysis. Surg Endosc 34, 510–520 (2020). https://doi.org/10.1007/s00464-019-07208-9

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