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One- and ten-year outcome of laparoscopic anterior 120° versus total fundoplication: a double-blind, randomized multicenter study

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Abstract

Background

Nissen fundoplication is an effective treatment for gastroesophageal reflux disease (GERD) but can cause adverse effects like flatulence and dysphagia. The aim was to compare laparoscopic anterior 120° fundoplication (APF) to total fundoplication (Nissen) concerning flatulence and other adverse effects, in a randomized blinded study.

Methods

Seventy-two patients were randomized to APF (n = 36) or Nissen (n = 36). Gastroscopy, 24-h pH monitoring and evaluation for symptoms and quality of life using questionnaires (GSRS, PGWB and 7-graded Likert scales) were performed preoperatively, at 1 and 10 years postoperatively. Patients and the researchers were blinded to operative method.

Results

When entering the study, most patients had mild–moderate reflux disease according to the symptom score, the 24-h pH measurements, and frequency and grade of esophagitis. At 1-year (n = 68) flatulence, dysphagia, heartburn and acid regurgitation did not differ between groups. More patients could belch (p = 0.005), and pH monitoring showed a higher time with pH < 4 in the APF group (p = 0.006). At 10 years (n = 61), the APF group reported less dysphagia (p < 0.001), more heartburn (p = 0.019) and more patients could belch (p = 0.012) and vomit (p < 0.001) compared to the Nissen. No difference remained at 10 years in pH monitoring (n = 23) between groups. Symptoms of heartburn and acid regurgitation were less than preoperatively in both groups (p < 0.001). No revisional operations were performed.

Conclusions

Both procedures offer good long-term control of reflux symptom, with modest post-fundoplication symptoms. Anterior 120° fundoplication results in less dysphagia, better ability to belch and vomit than total fundoplication at 10-year follow-up. The results suggest that APF could be an alternative to Nissen fundoplication in the surgical treatment of mild–moderate GERD.

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Acknowledgments

The authors thank research nurse Maria Lithner for collecting the 8-week postoperative data by calling the patients weekly and Anna and Edwin Berger’s foundation for providing financial support.

Disclosures

Dr Pauline Djerf has received unrestricted grant from Anna and Edwin Berger’s foundation, October 2013, Lidingö, Stockholm. Drs. Agneta Montgomery, Bengt Hallerbäck, Hans-Olof Håkansson and Folke Johnsson have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Skåne University Hospital, 221 85, Lund, Sweden

    Pauline Djerf & Folke Johnsson

  2. Clinical Sciences, Lund University, Lund, Sweden

    Pauline Djerf & Folke Johnsson

  3. Department of Surgery, Skåne University Hospital, Malmö, Sweden

    Agneta Montgomery

  4. Department of Surgery, Norra Älvsborg County Hospital, Trollhättan, Sweden

    Bengt Hallerbäck

  5. Department of Surgery, Kalmar County Hospital, Kalmar, Sweden

    Hans-Olof Håkansson

Authors
  1. Pauline Djerf
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  2. Agneta Montgomery
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  3. Bengt Hallerbäck
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  4. Hans-Olof Håkansson
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  5. Folke Johnsson
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Correspondence to Pauline Djerf.

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Djerf, P., Montgomery, A., Hallerbäck, B. et al. One- and ten-year outcome of laparoscopic anterior 120° versus total fundoplication: a double-blind, randomized multicenter study. Surg Endosc 30, 168–177 (2016). https://doi.org/10.1007/s00464-015-4177-y

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  • DOI: https://doi.org/10.1007/s00464-015-4177-y

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