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

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

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

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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

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