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Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial
D I Watson1, G G Jamieson, G K Pike
1The Royal Adelaide Centre for Endoscopic Surgery and University Department of Surgery, Royal Adelaide Hospital, South Australia, Australia.
The British Journal of Surgery
|February 23, 1999
Summary
Laparoscopic anterior fundoplication offers better outcomes for reflux surgery patients. This approach reduces dysphagia and improves satisfaction compared to Nissen fundoplication, with similar reflux control.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Reflux Management
Background:
- Gastro-oesophageal reflux surgery requires balancing reflux control and dysphagia.
- The optimal surgical technique for laparoscopic antireflux surgery remains undetermined.
Purpose of the Study:
- To compare laparoscopic anterior fundoplication with laparoscopic Nissen fundoplication.
- To assess postoperative dysphagia and reflux control efficacy.
Main Methods:
- Randomized controlled trial comparing Nissen fundoplication (n=53) and anterior hemifundoplication (n=54).
- Blinded patient assessment of dysphagia, heartburn, and satisfaction at 1, 3, and 6 months.
- Objective measures included lower oesophageal sphincter pressure, oesophageal emptying, and acid exposure.
Main Results:
- Operating times were comparable between procedures.
- Anterior fundoplication showed lower sphincter pressures and faster oesophageal emptying.
- At 6 months, anterior fundoplication resulted in significantly less dysphagia and higher patient satisfaction.
Conclusions:
- Laparoscopic anterior fundoplication provides equivalent reflux control with improved functional outcomes.
- The procedure demonstrates more physiological manometry results and better patient satisfaction at 6 months.
- Long-term efficacy of anterior fundoplication requires further investigation.