Skip to main content
SpringerLink
Log in

A prospective randomized trial on laparoscopic total vs partial fundoplication in patients with atypical symptoms of gastroesophageal reflux disease

  • Research
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Currently very little is known about the impact of anti-reflux surgery on extra-esophageal manifestations of gastroesophageal reflux disease (GERD) when compared with the typical symptoms of reflux. The aim of our study was to evaluate the clinical effect of total (360°) and partial (270°) laparoscopic fundoplication on extraesophageal GERD symptoms.

Methods

One hundred and twenty patients with documented extraesophageal GERD symptoms were randomized to either undergo floppy Nissen (n= 60) or Toupet fundoplication (n= 60). Symptom scores of throat clearing, globus sensation, cough, throat pain, and vocal changes were prospectively evaluated. A reflux symptom index (RSI) questionnaire was used to accurately document the improvement of extraesophageal symptoms. Quality of life was determined according to the laryngopharyngeal reflux–health-related quality of life (LPR–HRQL) questionnaire.

Results

No significant differences were identified between the groups regarding demographic data, such as age, gender, or body mass index. The median RSI score before operation and at 24-month follow-up was 22.8 ± 5.3 and 10.4 ± 5.4 respectively in the laparoscopic Nissen fundoplication (LNF) group (p < 0.05) and 21.7 ± 5.0 and 11.6 ± 5 respectively in the laparoscopic Toupet fundoplication (LTF) group (p < 0.05). The median LPR–HRQL score in the LNF group improved from 42.9 ± 13.8 before treatment to 10.7 ± 6.5 at 24 months (p < 0.05). In the LTF group, there was an improvement in the median LPR–HRQL score from 40.4 ± 10.9 prior to treatment to 11.7 ± 5.7 at 24 months (p < 0.05). The median RSI score and LPR–HRQL scores were similar between the groups at follow-up (p > 0.05).

Conclusions

Our report demonstrates that LNF and LTF provide equivalently good results for patients with extraesophageal manifestations of GERD. Quality of life is similar after LNF and LTF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jaspersen D, Kulig M, Labenz J, Leodolter A, Lind T, Meyer-Sabellek W, Vieth M, Willich SN, Lindner D, Stolte M, Malfertheiner P (2003) Prevalence of extra-oesophageal manifestations in gastro-oesophageal reflux disease: an analysis based on the ProGERD study. Aliment Pharmacol Ther. https://doi.org/10.1046/j.1365-2036.2003.01606.x

  2. Ates F, Vaezi MF (2013) Approach to the patient with presumed extraoesophageal GERD. Best Pract Res Clin Gastroenterol. https://doi.org/10.1016/j.bpg.2013.06.009

  3. Formánek M, Jančatová D, Komínek P, Tomanová R, Zeleník K (2017) Comparison of impedance and pepsin detection in the laryngeal mucosa to determine impedance values that indicate pathological laryngopharyngeal reflux. Clin Transl Gastroenterol. https://doi.org/10.1038/ctg.2017.49

  4. Gyawali CP, Fass R (2018) Management of gastroesophageal reflux disease. Gastroenterology. https://doi.org/10.1053/j.gastro.2017.07.049

  5. Dickman R, Boaz M, Aizic S, Beniashvili Z, Fass R, Niv Y (2011) Comparison of clinical characteristics of patients with gastroesophageal reflux disease who failed proton pump inhibitor therapy versus those who fully responded. J Neurogastroenterol Motil. https://doi.org/10.5056/jnm.2011.17.4.387

  6. Yadlapati R, Hungness ES, Pandolfino JE (2018) Complications of antireflux surgery. Am J Gastroenterol 2018. https://doi.org/10.1038/s41395-018-0115-7

  7. Bramhall SR, Mourad MM (2019) Wrap choice during fundoplication. World J Gastroenterol. https://doi.org/10.3748/wjg.v25.i48.6876

  8. Du X, Hu Z, Yan C, Zhang C, Wang Z, Wu J (2016) A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults. BMC Gastroenterol. https://doi.org/10.1186/s12876-016-0502-8

  9. Tian ZC, Wang B, Shan CX, Zhang W, Jiang DZ, Qiu M (2015) A meta-analysis of randomized controlled trials to compare long-term outcomes of Nissen and Toupet fundoplication for gastroesophageal reflux disease. PLoS One. https://doi.org/10.1371/journal.pone.0127627

  10. Håkanson BS, Lundell L, Bylund A, Thorell A (2019) Comparison of laparoscopic 270° posterior partial fundoplication vs total fundoplication for the treatment of gastroesophageal reflux disease: a randomized clinical trial. JAMA Surg. https://doi.org/10.1001/jamasurg.2019.0047

  11. Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the reflux symptom index (RSI). J Voice. https://doi.org/10.1016/s0892-1997(02)00097-8

  12. Carrau RL, Khidr A, Gold KF, Crawley JA, Hillson EM, Koufman JA, Pashos CL (2005) Validation of a quality-of-life instrument for laryngopharyngeal reflux. Arch Otolaryngol Head Neck Surg. https://doi.org/10.1001/archotol.131.4.315

  13. Catania RA, Kavic SM, Roth JS, Lee TH, Meyer T, Fantry GT, Castellanos PF, Park A (2007) Laparoscopic Nissen fundoplication effectively relieves symptoms in patients with laryngopharyngeal reflux. J Gastrointest Surg. https://doi.org/10.1007/s11605-007-0318-5

  14. Suzuki T, Seki Y, Okamoto Y, Hoppo T (2018) Hypopharyngeal multichannel intraluminal impedance leads to the promising outcome of antireflux surgery in Japanese population with laryngopharyngeal reflux symptoms. Surg Endosc. https://doi.org/10.1007/s00464-017-5940-z

  15. 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

  16. Mickevicius A, Endzinas Z, Kiudelis M, Jonaitis L, Kupcinskas L, Maleckas A, Pundzius J (2008) Influence of wrap length on the effectiveness of Nissen and Toupet fundoplication: a prospective randomized study. Surg Endosc. https://doi.org/10.1007/s00464-008-9852-9

  17. 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

  18. Slater BJ, Dirks RC, McKinley SK, Ansari MT, Kohn GP, Thosani N, Qumseya B, Billmeier S, Daly S, Crawford C, P Ehlers A, Hollands C, Palazzo F, Rodriguez N, Train A, Wassenaar E, Walsh D, Pryor AD, Stefanidis D (2021) SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD). Surg Endosc. https://doi.org/10.1007/s00464-021-08625-5

  19. Cicala M, Gabbrielli A, Emerenziani S, Guarino MP, Ribolsi M, Caviglia R, Costamagna G (2005) Effect of endoscopic augmentation of the lower oesophageal sphincter (Gatekeeper reflux repair system) on intraoesophageal dynamic characteristics of acid reflux. Gut. https://doi.org/10.1136/gut.2004.040501

  20. Özdemir P, Erdinç M, Vardar R, Veral A, Akyıldız S, Özdemir Ö, Bor S (2017) The role of microaspiration in the pathogenesis of gastroesophageal reflux-related chronic cough. J Neurogastroenterol Motil. https://doi.org/10.5056/jnm16057

  21. Kirkby-Bott J, Jones E, Perring S, Hosking SW (2011) Proximal acid reflux treated by fundoplication predicts a good outcome for chronic cough attributable to gastro-oesophageal reflux disease. Langenbecks Arch Surg. https://doi.org/10.1007/s00423-010-0702-6

  22. McKinley SK, Dirks RC, Walsh D, Hollands C, Arthur LE, Rodriguez N, Jhang J, Abou-Setta A, Pryor A, Stefanidis D, Slater BJ (2021) Surgical treatment of GERD: systematic review and meta-analysis. Surg Endosc. https://doi.org/10.1007/s00464-021-08358-5

  23. Aiolfi A, Cavalli M, Saino G, Khor D, Sozzi A, Rausa E, Bonitta G, Bona D (2020) Laparoscopic Toupet fundoplication for the treatment of laryngopharyngeal reflux: results at medium-term follow-up. World J Surg. https://doi.org/10.1007/s00268-020-05653-5

  24. Carroll TL, Nahikian K, Asban A, Wiener D (2016) Nissen fundoplication for laryngopharyngeal reflux after patient selection using dual pH, full column impedance testing: a pilot study. Ann Otol Rhinol Laryngol. https://doi.org/10.1177/0003489416649974

  25. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ (2022) ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. https://doi.org/10.14309/ajg.0000000000001538

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Danylo Halytsky Lviv National Medical University, 69 Pekarska str, Lviv, 79010, Ukraine

    Mykola Paranyak

  2. Liverpool University Hospitals Foundation Trust, Liverpool, England, UK

    Rikesh Patel

Authors
  1. Mykola Paranyak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rikesh Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Mykola Paranyak: study concept and design, acquisition of data. Both authors (i.e., Mykola Paranyak and Rikesh Patel) contributed to the analysis and interpretation of data and writing the paper.

Corresponding author

Correspondence to Mykola Paranyak.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paranyak, M., Patel, R. A prospective randomized trial on laparoscopic total vs partial fundoplication in patients with atypical symptoms of gastroesophageal reflux disease. Langenbecks Arch Surg 408, 269 (2023). https://doi.org/10.1007/s00423-023-03013-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00423-023-03013-0

Keywords

Search

Navigation