Abstract
Introduction
Nissen fundoplication can be followed by side effects, and this has driven modifications, including partial fundoplications. We previously reported early outcomes from a randomised trial of Nissen vs anterior 90° partial fundoplication. This paper reports 5-year follow-up outcomes to determine whether anterior 90° fundoplication achieves a satisfactory longer-term outcome.
Methods
From February 1999 to August 2003, 79 patients were randomised to Nissen vs anterior 90° fundoplication. Patients were followed yearly using a standardized clinical questionnaire which included symptom scores to assess heartburn, dysphagia, other post-fundoplication side effects and overall satisfaction with the outcome. Five-year clinical outcomes were analysed.
Results
Seventy-four patients were available for follow-up at 5 years. There were no significant differences for heartburn or satisfaction, although more patients used antisecretory medication after anterior 90° fundoplication (29.7 vs 8.1 %). Dysphagia was greater after Nissen fundoplication when measured by an analogue score for solid food and a composite dysphagia score. Symptoms of bloating were more common following Nissen fundoplication (80.0 vs 32.4 %), and less patients could eat a normal diet (78.4 vs 94.6 %). Re-operation was undertaken in four patients after Nissen fundoplication (dysphagia, three; hiatus hernia, one) vs three after anterior 90° fundoplication (recurrent reflux, three).
Conclusions
At 5 years, anterior 90° partial fundoplication was associated with less side effects, offset by greater use of antisecretory medication. Reflux symptoms and overall satisfaction were similar to Nissen fundoplication. Laparoscopic anterior 90° partial fundoplication is an effective treatment for gastro-esophageal reflux.
Similar content being viewed by others
References
Engström C, Jamieson GG, Devitt PG, Watson DI. Meta-analysis of two randomized controlled trials to identify long-term symptoms after division of short gastric vessels during Nissen fundoplication. Br J Surg 2011;98:1063-1067.
Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lonroth H & Olbe L. Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-esophageal reflux. Br J Surg 1996;83:830-835.
Booth MI, Stratford J, Jones L, Dehn TC. Randomized clinical trial of laparoscopic total (Nissen) versus posterior partial (Toupet) fundoplication for gastro-esophageal reflux disease based on preoperative esophageal manometry. Br J Surg 2008;95:57-63.
Ludemann R, Watson DI, Jamieson GG, Game PA, Devitt PG. Five-year follow-up of a randomized clinical trial of laparoscopic total versus anterior 180 degrees fundoplication. Br J Surg 2005;92:240-243.
Cai W, Watson DI, Lally CJ, Devitt PG, Game PA, Jamieson GG. Ten-year clinical outcome of a prospective randomized clinical trial of laparoscopic Nissen versus anterior 180° partial fundoplication. Br J Surg 2008;95:1501-1505.
Nijjar R, Watson D, Jamieson G, Archer S. Five-year follow-up of a multicenter, double-blind randomized clinical trial of laparoscopic Nissen vs anterior 90 degrees partial fundoplication. Arch Surg 2010;145:552-557.
Engström C, Lönroth H, Mardani J, Lundell L. An anterior or posterior approach to partial fundoplication? Long-term results of a randomized trial. World J Surg 2007;31:1221-1225.
Baigrie RJ, Cullis SN, Ndhluni AJ, Cariem A. Randomized double-blind trial of laparoscopic Nissen fundoplication versus anterior partial fundoplication. Br J Surg 2005;92:819-823.
Spence GM, Watson DI, Jamieson GG, Lally CJ, Devitt PG. Single center prospective randomized trial of laparoscopic Nissen versus anterior 90 degrees fundoplication. J Gastrointest Surg 2006;10:698-705.
Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen fundoplication. Ann Surg 1994;220:137-145.
Krysztopik RJ, Jamieson, GG, Devitt PG & Watson DI. A further modification of the Nissen fundoplication – 90° anterior fundoplication. Surg Endosc 2002;16:1446-1451.
Dakkak M & Bennett J. A new dysphagia score with objective validation, J Clin Gastroenterol 1992;14:99-100.
Watson DI, Jamieson GG, Pike GK, Davies N, Richardson M & Devitt PG. Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg 1999;86:123-30.
Yau P, Watson DI, Ascott N, Lafullarde T & Jamieson GG. Efficacy of a 90° anterior fundoplication versus a total fundoplication in an experimental model. Surg Endosc 2000;14:830-833.
Watson DI, Jamieson GG, Lally C, Archer S, Bessell JR, Booth M et al. Multicenter, prospective, double-blind, randomized trial of laparoscopic Nissen vs anterior 90 degrees partial fundoplication. Arch Surg 2004;139:1160-1167.
Broeders JA, Roks DJ, Jamieson GG, Devitt PG, Baigrie RJ, Watson DI. Five year outcome after laparoscopic anterior partial versus Nissen fundoplication - 4 randomized trials. Ann Surg 2012;255:637-642.
Wijnhoven BPL, Lally CJ, Kelly JJ, Myers JC, Watson DI. Use of Anti-Reflux Medication After Anti-Reflux Surgery. J Gastrointest Surg 2008;12:510-517.
Acknowledgments
This trial was supported by research project grants from the National Health and Medical Research Council (NHMRC) of Australia (grant numbers 157986 and 375111). We are grateful for the assistance of Ms. J. Sullivan, Ms. N. Carney and Ms. C. Lally who contributed to follow-up data collection.
Author information
Authors and Affiliations
Corresponding author
Additional information
Trial registration—This trial is registered with the Australia and New Zealand Clinical Trials Registry ACTRN12607000304437.
Rights and permissions
About this article
Cite this article
Watson, D.I., Devitt, P.G., Smith, L. et al. Anterior 90° Partial vs Nissen Fundoplication—5 Year Follow-Up of a Single-Centre Randomised Trial. J Gastrointest Surg 16, 1653–1658 (2012). https://doi.org/10.1007/s11605-012-1920-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-012-1920-8