Journal of Gastrointestinal Surgery

, Volume 16, Issue 9, pp 1653–1658 | Cite as

Anterior 90° Partial vs Nissen Fundoplication—5 Year Follow-Up of a Single-Centre Randomised Trial

  • David Ian Watson
  • Peter G. Devitt
  • Lorelle Smith
  • Glyn G. Jamieson
Original Article



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.


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.


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).


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.


Gastro-esophageal reflux disease Nissen fundoplication Anterior partial fundoplication Laparoscopy Randomised controlled trial 


  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.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;92:240-243.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen fundoplication. Ann Surg 1994;220:137-145.PubMedCrossRefGoogle Scholar
  11. 11.
    Krysztopik RJ, Jamieson, GG, Devitt PG & Watson DI. A further modification of the Nissen fundoplication – 90° anterior fundoplication. Surg Endosc 2002;16:1446-1451.PubMedCrossRefGoogle Scholar
  12. 12.
    Dakkak M & Bennett J. A new dysphagia score with objective validation, J Clin Gastroenterol 1992;14:99-100.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • David Ian Watson
    • 1
  • Peter G. Devitt
    • 2
  • Lorelle Smith
    • 1
    • 2
  • Glyn G. Jamieson
    • 2
  1. 1.Flinders University Department of SurgeryFlinders Medical CentreAdelaideAustralia
  2. 2.Discipline of SurgeryUniversity of Adelaide, Royal Adelaide HospitalAdelaideAustralia

Personalised recommendations