Journal of Gastrointestinal Surgery

, Volume 12, Issue 8, pp 1341–1345 | Cite as

Esophageal pH Profile Following Laparoscopic Total Fundoplication Compared to Anterior Fundoplication

  • Andrew S. Y. Wong
  • Jennifer C. Myers
  • Glyn G. JamiesonEmail author
original aricle


In Barrett’s esophagus, total abolition of reflux may give maximum protection against the development of malignancy. To determine whether laparoscopic anterior fundoplication gives the same degree of antireflux control as a total fundoplication, we analyzed a prospectively followed cohort of patients from randomized controlled trials of laparoscopic antireflux surgery. There were 167 patients who returned for routine esophageal pH studies within 6 months of surgery (123 laparoscopic total fundoplications and 44 anterior fundoplications). There was no difference in percentage time pH <4 between fundoplication groups, but the total number of reflux episodes was significantly different (total fundoplication, four reflux events vs. partial fundoplication, six reflux events; p = 0.03). It is difficult to believe that this difference is either biologically or clinically important. In patients with a second esophageal pH study more than 5 years later, both the percentage time pH <4 (0.1% total fundoplication vs. 2.7% partial fundoplication; p = 0.004) and total number of reflux episodes (three total fundoplication vs. 24 partial fundoplication; p = 0.002) were significantly different. However, the postoperative esophageal acid exposure was within the normal range for both total and partial fundoplication, so whether the statistical difference is clinically important, remains a moot point.


Laparoscopic fundoplication Gastro-esophageal reflux Esophageal pH monitoring Randomized controlled trial 



We would like to thank Carolyn Lally for her help with the fundoplication database and Thomas Sullivan for his advice on statistical analysis.


  1. 1.
    Spence GM, Watson DI, Jamiesion GG, Lally CJ, Devitt PG. Single center prospective randomized trial of laparoscopic Nissen versus anterior 90 degrees fundoplication. J Gastrointest Surg 2006;10(5):698–705.PubMedCrossRefGoogle Scholar
  2. 2.
    Watson DI, Jamieson GG, Lally C, Archer S, Bessell JR, Booth M, Cade R, Cullingford G, Devitt PG, Fletcher DR, Hurley J, Kiroff G, Martin CJ, Martin IJ, Nathanson LK, Windsor JA. Multicenter, prospective, double-blind, randomized trial of laparoscopic nissen vs anterior 90 degrees partial fundoplication. Arch Surg 2004;139(11):1160–1167.PubMedCrossRefGoogle Scholar
  3. 3.
    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(7):819–823.PubMedCrossRefGoogle Scholar
  4. 4.
    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(2):240–243.PubMedCrossRefGoogle Scholar
  5. 5.
    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(1):123–130.PubMedCrossRefGoogle Scholar
  6. 6.
    Galvani C, Fisichella PM, Gorodner MV, Perretta S, Patti MG. Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease: role of esophageal functions tests. Arch Surg 2003;138(5):514–518. discussion 518–519.PubMedCrossRefGoogle Scholar
  7. 7.
    Khajanchee Y, O’Rourke R, Lockhart B, Patterson E, Hansen P, Swanstrom L. Postoperative symptoms and failure after antireflux surgery. Archives of surgery (Chicago, IL: 1960) 2002;137(9):1008–1013. discussion 1013–1004.Google Scholar
  8. 8.
    Thompson SK, Jamieson GG, Myers JC, Chin KF, Watson DI, Devitt PG. Recurrent Heartburn after Laparoscopic Fundoplication is Not Always Recurrent Reflux. J Gastrointest Surg 2007;11(5):642–647.PubMedCrossRefGoogle Scholar
  9. 9.
    Lord RV, Kaminski A, Oberg S, Bowrey DJ, Hagen JA, DeMeester SR, Sillin LF, Peters JH, Crookes PF, DeMeester TR. Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg 2002;6(1):3–9. discussion 10.PubMedCrossRefGoogle Scholar
  10. 10.
    American Gastroenterological Association. Medical position statement: Guidelines on the use of esophageal pH recording. Gastroenterology 1996;110(6):1981–1996.CrossRefGoogle Scholar
  11. 11.
    DeMeester TR. Prolonged Oesophageal pH Monitoring. In Read NW, ed. Gastrointestinal motility: Which Test? UK: Wrightson Biomedical Publishing Ltd, 1989, pp 41–52.Google Scholar
  12. 12.
    Watson DI, Jamieson GG, Devitt PG, Kennedy JA, Ellis T, Ackroyd R, Lafullarde T, Game PA. A prospective randomized trial of laparoscopic Nissen fundoplication with anterior vs posterior hiatal repair. Arch Surg 2001;136(7):745–751.PubMedCrossRefGoogle Scholar
  13. 13.
    Watson DI, Pike GK, Baigrie RJ, Mathew G, Devitt PG, Britten-Jones R, Jamieson GG. Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 1997;226(5):642–652.PubMedCrossRefGoogle Scholar
  14. 14.
    Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen fundoplication. Ann Surg 1994;220(2):137–145.PubMedCrossRefGoogle Scholar
  15. 15.
    Krysztopik RJ, Jamieson GG, Devitt PG, Watson DI. A further modification of fundoplication. 90 degrees anterior fundoplication. Surg Endosc 2002;16(10):1446–1451.PubMedCrossRefGoogle Scholar
  16. 16.
    Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lönroth H, Olbe L. Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg 1996;83(6):830–835.PubMedCrossRefGoogle Scholar
  17. 17.
    Zornig C, Strate U, Fibbe C, Emmermann A, Layer P. Nissen vs Toupet laparoscopic fundoplication. Surg Endosc 2002;16(5):758–766.PubMedCrossRefGoogle Scholar
  18. 18.
    Chrysos E, Athanasakis E, Pechlivanides G, Tzortzinis A, Mantides A, Xynos E. The effect of total and anterior partial fundoplication on antireflux mechanisms of the gastroesophageal junction. Am J Surg 2004;188(1):39–44.PubMedCrossRefGoogle Scholar
  19. 19.
    Yau P, Watson D, Devitt P, Game P, Jamieson G. Laparoscopic antireflux surgery in the treatment of gastroesophageal reflux in patients with Barrett esophagus. Archives of surgery (Chicago, IL: 1960) 2000;135(7):801–805.Google Scholar
  20. 20.
    Chang E, Morris C, Seltman A, O’Rourke R, Chan B, Hunter J, Jobe B. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: A systematic review. Ann Surg 2007;246(1):11–21.PubMedCrossRefGoogle Scholar
  21. 21.
    Rice S, Watson DI, Lally CJ, Devitt PG, Game PA, Jamieson GG. Laparoscopic anterior 180 degrees partial fundoplication: Five-year results and beyond. Arch Surg 2006;141(3):271–275.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Andrew S. Y. Wong
    • 1
  • Jennifer C. Myers
    • 1
  • Glyn G. Jamieson
    • 1
    Email author
  1. 1.Discipline of SurgeryUniversity of Adelaide, Royal Adelaide HospitalAdelaideAustralia

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