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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

Abstract

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.

Keywords

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

Notes

Acknowledgments

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

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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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