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Open vs laparoscopic partial posterior fundoplication

A prospective randomized trial

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Abstract

Objective

This study compares outcomes following open and laparoscopic partial posterior fundoplication for gastroesophageal reflux disease concerning perioperative course, postoperative complications, symptomatic relief, recurrent disease, and the need for reinterventional surgery.

Methods

A prospective randomized trial was performed. Pre- and postoperative testing included endoscopy, esophageal function testing, patient questionnaire, and clinical assessment. Patients were followed for three years.

Materials

Ninety-three patients were randomized to open and 99 to laparoscopic surgery.

Results

Complication rates were higher, and length of stay (LOS) [5 (3–36) vs 3 (1–12) days] and time off work [42 (12–76) vs 28 (0–108) days] was longer in the open group (p < 0.01). Early side effects and recurrences were more common (p < 0.05) in the laparoscopic group. One patient in the open group and 8 patients in the laparoscopic group required surgery for recurrent disease and 7 patients required surgery for incisional hernias after open surgery. Overall, at one and three years, there were no differences in patient-assessed satisfactory outcome (93.5/93.5 vs 88.8/90.8%) or reflux control (p = 0.53) between the open and laparoscopic groups.

Conclusions

The finding of fewer general complications, shorter length of stay and recovery, similar need for reoperations, and comparable 3-year outcomes, makes the laparoscopic approach the primary choice when considering surgical options for the treatment of gastroesophageal reflux disease (GERD).

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References

  1. Geagea T (1991) Laparoscopic Nissen’s fundoplication: preliminary report on ten cases. Surg Endosc 5: 170–173

    Article  CAS  Google Scholar 

  2. Dallemagne B, Weerts JM, Jehaes C, et al. (1991) Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1: 138–143

    CAS  PubMed  Google Scholar 

  3. Sandbu R, Khamis H, Gustavsson S, Haglund U (2002) Long-term results of antireflux surgery indicate the need for a randomized clinical trial. Br J Surg 89: 225–230

    CAS  PubMed  Google Scholar 

  4. Bais JE, Bartelsman JF, Bonjer HJ, et al. (2000) Laparoscopic or conventional Nissen fundoplication for gastro-oesophageal reflux disease: randomised clinical trial. The Netherlands Antireflux Surgery Study Group. Lancet 355: 170–174

    Article  CAS  Google Scholar 

  5. Spechler SJ, Lee E, Ahnen D, et al. (2001) Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 285: 2331–2338

    Article  CAS  Google Scholar 

  6. Henderson RD, Marryatt G (1983) Total fundoplication gastroplasty: long-term follow-up in 500 patients. J Thorac Cardiovasc Surg 85: 81–87

    CAS  PubMed  Google Scholar 

  7. Donahue PE, Samelson S, Nyhus LM, Bombeck CT (1985) The floppy Nissen fundoplication: effective long-term control of pathologic reflux. Arch Surg 120: 663–668

    Article  CAS  Google Scholar 

  8. DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients. Ann Surg 204: 9–20

    Article  CAS  Google Scholar 

  9. Johansson J, Johnsson F, Joelsson B, et al. (1993) Outcome 5 years after 360 degree fundoplication for gastro-oesophageal reflux disease. Br J Surg 80: 46–49

    Article  CAS  Google Scholar 

  10. Weerts JM, Dallemagne B, Hamoir E, et al. (1993) Laparoscopic Nissen fundoplication: detailed analysis of 132 patients. Surg Laparosc Endosc 3: 359–364

    CAS  PubMed  Google Scholar 

  11. Anvari M, Allen C (2003) Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. J Am Coll Surg 196: 51–57; discussion 7–8; author reply 8–9

    Article  Google Scholar 

  12. Perttila J (1999) Immune response after laparoscopic and conventional Nissen fundoplication. Eur J Surg 165: 21–28

    Article  CAS  Google Scholar 

  13. Heikkinen TJ (1999) Comparison of costs between laparoscopic and open Nissen fundoplication: a prospective randomized study with a 3-month followup. J Am Coll Surg 188: 368–376

    Article  CAS  Google Scholar 

  14. Ackroyd R, Watson DI, Majeed AW, et al. (2004) Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux disease. Br J Surg 91: 975–982

    Article  CAS  Google Scholar 

  15. Chrysos E, Tsiaoussis J, Athanasakis E, et al. (2002) Laparoscopic vs open approach for Nissen fundoplication: a comparative study. Surg Endosc 16: 1679–1684

    Article  CAS  Google Scholar 

  16. Nilsson G (2000) Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period. Br J Surg 87: 873–878

    Article  CAS  Google Scholar 

  17. Laine S (1997) Laparoscopic vs conventional Nissen fundoplication: a prospective randomized study. Surg Endosc 11: 441–444

    Article  CAS  Google Scholar 

  18. Luostarinen M, Virtanen J, Koskinen M, et al. (2001) Dysphagia and oesophageal clearance after laparoscopic versus open Nissen fundoplication: a randomized, prospective trial. Scand J Gastroenterol 36: 565–571

    Article  CAS  Google Scholar 

  19. Sietses C (1999) A prospective randomized study of the systemic immune response after laparoscopic and conventional Nissen fundoplication. Surgery 126: 5–9

    Article  CAS  Google Scholar 

  20. Toupet A (1963) Technic of esophago-gastroplasty with phrenogastropexy used in radical treatment of hiatal hernias as a supplement to Heller’s operation in cardiospasms. Mem Acad Chir (Paris) 89: 384–389

    CAS  Google Scholar 

  21. Thor KB, Silander T (1989) A long-term randomized prospective trial of the Nissen procedure versus a modified Toupet technique. Ann Surg 210: 719–724

    Article  CAS  Google Scholar 

  22. Lundell L, Abrahamsson H, Ruth M, et al. (1996) Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg 83: 830–835

    Article  CAS  Google Scholar 

  23. O’Reilly MJ, Mullins SG, Saye WB, et al. (1996) Laparoscopic posterior partial fundoplication: analysis of 100 consecutive cases. J Laparoendosc Surg 6: 141–150

    Article  Google Scholar 

  24. Franzén T, Boström J, Tibbling Grahn L, Johansson K (1999) Prospective study of symptoms and gastro-oesophageal reflux 10 years after posterior partial fundoplication. Br J Surg 86: 956–960

    Article  Google Scholar 

  25. Arndorfer RC, Stef JJ, Dodds WJ, et al. (1977) Improved infusion system for intraluminal esophageal manometry. Gastroenterology 73: 23–27

    Article  CAS  Google Scholar 

  26. DeMeester TR, Wang CI, Wernly JA, et al. (1980) Technique, indications, and clinical use of 24 hour esophageal pH monitoring. J Thorac Cardiovasc Surg 79: 656–670

    CAS  PubMed  Google Scholar 

  27. Savary M, Miller G (1977) Der Oesophagus - Lehrbuch und endoskopischer Atlas: Verlag Gassman Ag, Solothurn, Switzerland

    Google Scholar 

  28. Ramel S, Thor K (1995) The Ersta procedure, a hemifundoplication for the treatment of gastro-oesophageal reflux disease. Ann Chir Gynaecol 84: 145–149

    CAS  PubMed  Google Scholar 

  29. Peters JH, Heimbucher J, Kauer WK, et al. (1995) Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication. J Am Coll Surg 180: 385–393

    CAS  PubMed  Google Scholar 

  30. Hunter JG, Smith CD, Branum GD, et al. (1999) Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision. Ann Surg 230: 595–604; discussion 604–606

    Article  CAS  Google Scholar 

  31. Johnsson E, Lundell L (2002) Repeat antireflux surgery: effectiveness of a toupet partial posterior fundoplication. Eur J Surg 168: 441–445

    Article  Google Scholar 

  32. Lundell L, Abrahamsson H, Ruth M, et al. (1991) Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360 degrees fundoplication: results of a prospective, randomized, clinical study. World J Surg 15: 115–120; discussion 121

    Article  CAS  Google Scholar 

  33. Sandbu R, Khamis H, Gustavsson S, Haglund U (2002) Laparoscopic antireflux surgery in routine hospital care. Scand J Gastroenterol 37: 132–137

    Article  CAS  Google Scholar 

  34. Watson DI, Jamieson GG, Game PA, et al. (1999) Laparoscopic reoperation following failed antireflux surgery. Br J Surg 86: 98–101

    Article  CAS  Google Scholar 

  35. Granderath FA, Kamolz T, Schweiger UM, Pointner R (2002) Long-term follow-up after laparoscopic refundoplication for failed antireflux surgery: quality of life, symptomatic outcome, and patient satisfaction. J Gastrointest Surg 6: 812–818

    Article  Google Scholar 

  36. Dutta S, Bamehriz F, Boghossian T, et al. (2004) Outcome of laparoscopic redo fundoplication. Surg Endosc 18: 440–443

    Article  CAS  Google Scholar 

  37. Israelsson LA, Jonsson T (1996) Incisional hernia after midline laparotomy: a prospective study. Eur J Surg 162: 125–129

    CAS  PubMed  Google Scholar 

  38. Bowrey DJ, Blom D, Crookes PF, et al. (2001) Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. Surg Endosc 15: 663–666

    Article  CAS  Google Scholar 

  39. Heikkinen TJ (2000) Comparison of laparoscopic and open Nissen fundoplication 2 years after operation: a prospective randomized trial. Surg Endosc 14: 1019–1023

    Article  CAS  Google Scholar 

  40. Heikkinen TJ, Haukipuro K, Sorasto A, et al. (2000) Short-term symptomatic outcome and quality of life after laparoscopic versus open Nissen fundoplication: a prospective randomized trial. Int J Surg Investig 2: 33–39

    CAS  PubMed  Google Scholar 

  41. Wenner J, Nilsson G, Oberg S, et al. (2001) Short-term outcome after laparoscopic and open 360 degrees fundoplication: a prospective randomized trial. Surg Endosc 15: 1124–1128

    Article  CAS  Google Scholar 

  42. Nilsson G, Larsson S, Johnsson F (2002) Randomized clinical trial of laparoscopic versus open fundoplication: evaluation of psychological well-being and changes in everyday life from a patient perspective. Scand J Gastroenterol 37: 385–391

    Article  CAS  Google Scholar 

  43. Nilsson G, Wenner J, Larsson S, Johnsson F (2004) Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux. Br J Surg 91: 552–559

    Article  CAS  Google Scholar 

  44. Cuschieri A, Hunter J, Wolfe B, et al. (1993) Multicenter prospective evaluation of laparoscopic antireflux surgery: preliminary report. Surg Endosc 7: 505–510

    Article  CAS  Google Scholar 

  45. Sandbu R, Hallgren T (2000) The economics of laparoscopic antireflux operations compared with open surgery. Eur J Surg Suppl 585: 37–39

    Article  Google Scholar 

  46. Kehlet H, Mogensen T (1999) Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 86: 227–230

    Article  CAS  Google Scholar 

  47. Shah J, Buckley D, Frisby J, Darzi A (2003) Depth cue reliance in surgeons and medical students. Surg Endosc 17: 1472–1474

    Article  CAS  Google Scholar 

  48. Krahenbuhl L (1998) Experimental study of adhesion formation in open and laparoscopic fundoplication. Br J Surg 85: 826–830

    Article  CAS  Google Scholar 

  49. Lord RV, Kaminski A, Oberg S, et al. (2002) Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg 6: 3–9; discussion 10

    Article  Google Scholar 

  50. Blomqvist AM, Lonroth H, Dalenback J, Lundell L (1998) Laparoscopic or open fundoplication? A complete cost analysis. Surg Endosc 12: 1209–1212

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Center for Gastrointestinal Disease, Ersta Hospital and Karolinska Institutet, Department for Clinical Science Intervention and Technology, Division of Surgery, Karolinska University Hospital, Huddinge, Sweden

    B. S. Håkanson, A. Thorell & O. Ljungqvist

  2. Queen Sophia Hospital, P.O. Box 5605, Se-11486, Stockholm, Sweden

    K. B. Å. Thor

Authors
  1. B. S. Håkanson
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  2. K. B. Å. Thor
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  3. A. Thorell
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  4. O. Ljungqvist
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Correspondence to B. S. Håkanson.

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Håkanson, B.S., Thor, K.B.Å., Thorell, A. et al. Open vs laparoscopic partial posterior fundoplication. Surg Endosc 21, 289–298 (2007). https://doi.org/10.1007/s00464-006-0013-8

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  • DOI: https://doi.org/10.1007/s00464-006-0013-8

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