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Long-term efficacy of total (Nissen-Rossetti) and posterior partial (Toupet) fundoplication: Results of a randomized clinical trial

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Journal of Gastrointestinal Surgery

Abstract

The efficacy of fundoplication operations in the long-term management of gastroesophageal reflux disease (GERD) has been documented. However, only a few prospective controlled series support the longterm (>10 years) efficacy of these procedures, and further data are required to also determine whether the type of fundoplication affects the frequency of postfundoplication complaints. The aim of this study was to conduct a randomized, controlled clinical trial to assess the long-term symptomatic outcome of a partial posterior fundoplication as compared to a total fundic wrap. During the years 1983 to 1991, a total of 13 7 patients with chronic gastroesophageal reflux disease were enrolled in the study; 72 were randomized to semifundoplication (Toupet) and 65 to total fundoplication (Nissen-Rossetti). A standardized symptom questionnaire was used for follow-up of these patients. A total of 110 patients completed a median follow-up of 11.5 years; 54 had a total wrap and 56 underwent a partial posterior fundoplication. During this period, seven patients required reoperation (Nissen-Rossetti in 5 and Toupet in 2), 11 patients died, and nine patients were lost to follow-up or did not comply with the follow-up program. Control of heartburn (no symptoms or mild, intermittent symptoms) was achieved in 88% and 92% in the total and partial fundoplication groups, respectively, and the corresponding figures for control of acid regurgitation were 90% and 94%. We observed no difference in dysphagia scoring between the two groups, although odynophagia was somewhat more frequently reported in those undergoing a total fundoplication. On the other hand, a significant difference was observed in the prevalence of rectal flatus and postprandial fullness, which were recorded significantly more often in those undergoing a total fundoplication (P < 0.001 and P < 0.03, respectively). Posterior partial fundoplication seems to maintain the same high level of reflux control as total fundoplication. Earlier observations demonstrating the advantages of a partial fundoplication, which included fewer complaints associated with gas-bloat, continue to be valid after more than 10 years of follow-up.

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References

  1. Watson DI, Jamieson GG. Antireflux surgery in the laparoscopic era. BrJ Surg 1998;85:1173–1184.

    Article  CAS  Google Scholar 

  2. Perdikis G, Hinder RA, Lund RJ, Raiser F, Katada N. Laparoscopic Nissen fundoplication: Where do we stand? Surg Laparosc Endosc 1997;7:17–21.

    Article  PubMed  CAS  Google Scholar 

  3. Ackermann C, Margreth L, Müller C, Harder F. Symptoms 10–20 years after fundoplication. In Siewert JR, Hölscher AH, eds. Diseases of the Esophagus. Berlin:Springer-Verlag, 1988;1198–1202.

    Google Scholar 

  4. Bremner RM, DeMeester TR, Crookes PF, Constantini M, Hoeft SF, Peters JF, Hagen J. The effect of symptoms and nonspecific motility abnormalities on outcomes of surgical therapy for gastroesophageal reflux disease. J Thorac Cardiovasc Surg 1994;107:1244–1250.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  6. Ellis FH, Crozier RE. Reflux control by fundoplication: A clinical and manometric assessment of the Nissen operation. Ann Thorac Surg 1984;38:387–392.

    Article  PubMed  Google Scholar 

  7. Isolauri J, Luostarinen M, Viljakka M, Isolauri E, Keyrilainen O, Karvonen AL. Long-term comparison of antireflux surgery versus conservative therapy for reflux esophagitis. Ann Surg 1997;225:295–299.

    Article  PubMed  CAS  Google Scholar 

  8. Johansson J, Johnsson F, Joelsson B, Florén CH, Walther B. Outcome 5 years after 360 fundoplication for gastrooesophageal reflux disease. Br J Surg 1993:80:46–49.

    Article  PubMed  CAS  Google Scholar 

  9. Luostarinen M. Nissen fundoplication for reflux esophagitis. Long-term clinical and endoscopic results in 109 of 127 consecutive patients. Ann Surg 1993:217:329–337.

    Article  PubMed  CAS  Google Scholar 

  10. Luostarinen M, Isolauri J, Laitinen J, Koskinen M, Keyrilainen O, Markkula H, Lehtinen E, Uusitalo A. Fate of Nissen fundoplication after 20 years. A clinical, endoscopical and functional analysis. Gut 1993:34:1015–1020.

    Article  PubMed  CAS  Google Scholar 

  11. MacIntyre IMC, Goulbourne IA. Long-term results after Nissen fundoplication: A 5–15-year review. J R Coll Surg Edinb 1990; 35:159–162.

    PubMed  CAS  Google Scholar 

  12. Martinez De Haro LF, Ortiz A, Paprilla P, Macilla JG, Aguauyo JL, Morales G. Long-term results of Nissen fundoplication in reflux esophagitis without strictures. Clinical, endoscopic, and pH-metric evaluation. Dig Dis 1992:37:523–527.

    Article  Google Scholar 

  13. Negre JB, Markkula HT, Keyrilainen O, Matakainen. Nissen fundoplication. Results at 10-year follow-up. Am J Surg 1983; 146:635–63 8.

    Article  PubMed  CAS  Google Scholar 

  14. Shirazi SS, Schulze K, Soper RT. Long-term follow-up for treatment of complicated chronic reflux esophagitis. Arch Surg 1987:122:548–551.

    PubMed  CAS  Google Scholar 

  15. Jamieson GG, Duranceau A. What is a Nissen fundoplication? Surg Gynaecol Obstet 1984:159:591–593.

    CAS  Google Scholar 

  16. Garstin WI, Hohnston GW, Kennedy TL, Spencer ES. Nissen fundoplication: The unhappy 15%. R Coll Surg Edinb 1986:31:207–209.

    CAS  Google Scholar 

  17. Watson A. Update: Total versus partial laparoscopic fundoplication. Dig Surg 1998;15:172–180.

    Article  PubMed  CAS  Google Scholar 

  18. Johnsson F, Holloway RH, Ireland AC, Jamieson GG, Dent J. Effect of fundoplication or transient lower oesophageal sphincter relaxation and gas reflux. Br J Surg 1997:84:686–689.

    Article  PubMed  CAS  Google Scholar 

  19. Lundell L, Abrahamsson H, Ruth M, Sandberg N, Olbe L. Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360 degrees fundoplication: Results of a prospective, randomised, clinical study. World J Surg 1991:15:115–120.

    Article  PubMed  CAS  Google Scholar 

  20. Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lönroth H, Olbe L. Long-term results of a prospective randomised comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-esophageal reflux. Br J Surg 1996; 83:830–835.

    Article  PubMed  CAS  Google Scholar 

  21. Laws HL, Clements RH, Swillie CM. A randomized, prospective comparison of the Nissen fundoplication versus the Toupet fundoplication for gastroesophageal reflux disease. Ann Surg 1997:225:647–654.

    Article  PubMed  CAS  Google Scholar 

  22. Horvath KD, Jobe BA, Herron DM, Swanstrom LL. Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J GASTROINTEST Surg 1999;583–591.

  23. Toupét A. Technique d’oesopgago-gastroplastie avec phre’nogastropexie appliquée dans la crure radicale des hernies hiatales et comme complément de l’operation d’Heller dans les cardiospasmes. Mem Acad Chir 1963:89:394–398.

    Google Scholar 

  24. Cameron AJ, Zinsmeister AR, Ballard DJ, Carney JA. Prevalence of columnar lined (Barrett’s) esophagus. Comparison of population based clinical and autopsy findings. Gastroenterology 1990:99:918–922.

    PubMed  CAS  Google Scholar 

  25. Rydberg L, Ruth M, Abrahamsson H, Lundell L. Tailoring antireflux surgery: A randomised clinical trial. World J Surg 1999:23:612–618.

    Article  PubMed  CAS  Google Scholar 

  26. Rydberg L, Ruth M, Lundell L. Mechanism of action of antireflux procedures. Br J Surg 1999:86:405–410.

    Article  PubMed  CAS  Google Scholar 

  27. Escandell AO, DeHaro LFM, Paricio PP, Albasini JLA, Marcilla JAG, Cuencea GM. Surgery improves defective esophageal peristalsis in patients with gastroesophageal reflux. Br J Surg 1991:78:1095–1097.

    Article  Google Scholar 

  28. Patterson EJ, Herron DM, Hansen PD, Ramzi N, Standage BA, Swanstrom LL. Effect of an esophageal bougie on the incidence of dysphagia following Nissen fundoplication. A prospective, blinded, randomised clinical trial. Arch Surg 2000:135:1055–1062.

    Article  PubMed  CAS  Google Scholar 

  29. FranzénJ, BoströmJ, Tibbling Grahn L, Johansson K-E. Prospective study of symptoms and gastro-oesophageal reflux 10 years after posterior partial fundoplication. Br J Surg 1999:86:956–960.

    Article  Google Scholar 

  30. Baxter ST, Walker SJ, Sutton R. A randomised control trial of Nissen versus Lind fundoplication. Results of 10 year follow-up. In Perakia A, ed. Recent Advances in Diseases of the Oesophagus. Bologna, Italy: Monduzzi Editore, 1996, pp 675–677.

    Google Scholar 

  31. Rydberg L, Ruth M, Abrahamsson H, Lundell L. Tailoring antireflux surgery: A randomized clinical trail. World J Surg 1999:23:612–618.

    Article  PubMed  CAS  Google Scholar 

  32. Tew S, Ackroyd R, Jamieson GG, Holloway RH. Belching and bloating: Facts and fantasy after antireflux surgery. Br J Surg 2000;87:477–481.

    Article  PubMed  CAS  Google Scholar 

  33. Carlson R, GalmicheJP, DentJ, Lundell L, Frison L. Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs; a meta-analysis of long-term omeprazole trials. Aliment Pharmacol Ther 1997:11:472–482.

    Article  Google Scholar 

  34. Csendes A, Braghetto I, Burdiles P, Puente G, Korn O, Diaz JC, Maluenda F. Long-term results of classic antireflux surgery in 152 patients with Barrett’s oesophagus: Clinical, radiological, endoscopic, manometric, and acid reflux test analysis before and late after operation. Surgery 1998; 123:645–657.

    PubMed  CAS  Google Scholar 

  35. Farrell TM, Smith CD, Metreveli RE, Johnsson AB, Galloway KD, Hunter JG. Fundoplication provides effective and durable symptom relief in patients with Barrett’s esophagus. AmJ Surg 1999:178:18–21.

    Article  CAS  Google Scholar 

  36. Lundell L, Miettinen P, Myrvold H, Pedersen SA, Liedman B, HatlebakkJG, Julkonen R Levander K, Carlsson J, Lam M, Wiklund I. Continued (5-year) follow-up of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease. J Am Coll Surg 2001:192:172–181.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Sahlgrenska University Hospital, S-413 45, Gothenburg, Sweden

    Cecilia Hagedorn M.D., Hans Lönroth M.D., Ph.D., Lars Rydberg M.D., Ph.D., Magnus Ruth M.D., Ph.D. & Lars Lundell D., Ph.D.

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  1. Cecilia Hagedorn M.D.
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  2. Hans Lönroth M.D., Ph.D.
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  3. Lars Rydberg M.D., Ph.D.
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  4. Magnus Ruth M.D., Ph.D.
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  5. Lars Lundell D., Ph.D.
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Correspondence to Cecilia Hagedorn M.D..

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Hagedorn, C., Lönroth, H., Rydberg, L. et al. Long-term efficacy of total (Nissen-Rossetti) and posterior partial (Toupet) fundoplication: Results of a randomized clinical trial. J Gastrointest Surg 6, 540–545 (2002). https://doi.org/10.1016/S1091-255X(02)00037-9

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  • DOI: https://doi.org/10.1016/S1091-255X(02)00037-9

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