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Surgical Endoscopy

, Volume 34, Issue 2, pp 510–520 | Cite as

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

  • Alexandros Andreou
  • David I. Watson
  • Dimitrios Mavridis
  • Nader K. Francis
  • Stavros A. AntoniouEmail author
Review Article

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.

Keywords

Fundoplication Antireflux surgery GERD Network meta-analysis 

Notes

Acknowledgements

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

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.

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.

Supplementary material

464_2019_7208_MOESM1_ESM.docx (1.4 mb)
Supplementary material 1 (DOCX 1424 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Upper GI Department, Castle Hill HospitalHull and East Yorkshire Hospitals NHS Foundation TrustHullUK
  2. 2.Flinders University Discipline of SurgeryFlinders Medical CentreBedford ParkAustralia
  3. 3.Department of Primary Education, School of EducationUniversity of IoanninaIoanninaGreece
  4. 4.Faculté de MédecineParis Descartes University, Sorbonne Paris CitéParisFrance
  5. 5.Department of General SurgeryYeovil District Hospital NHS Foundation TrustYeovilUK
  6. 6.Department of SurgeryEuropean University CyprusNicosiaCyprus
  7. 7.Department of SurgeryMediterranean Hospital of CyprusLimassolCyprus
  8. 8.AthensGreece

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