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Updated: Apr 21, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Partial versus complete fundoplication for the correction of pediatric GERD: a systematic review and meta-analysis
Peter Glen1, Michaël Chassé2, Mary-Anne Doyle3
1University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Insights
Current evidence does not show a difference in surgical success between complete (360-degree) and partial fundoplication for gastroesophageal reflux disease (GERD). Further high-quality research is needed to compare these surgical techniques for GERD management.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- The optimal extent of fundoplication for gastroesophageal reflux disease (GERD) in children remains debated.
- Lack of consensus exists regarding the required degree of fundic wrap for effective GERD correction.
Purpose of the Study:
- To compare the efficacy of complete (360-degree) versus partial fundoplication in controlling GERD.
- To evaluate secondary outcomes including dysphagia and complications associated with different fundoplication techniques.
Main Methods:
- Systematic literature search of MEDLINE and Scopus for studies on pediatric fundoplication.
- Inclusion of randomized controlled trials (RCTs) and observational studies comparing surgical techniques.
- Meta-analysis of pooled data and assessment of study quality using the Cochrane Risk of Bias Tool.
Main Results:
- Two RCTs and 12 cohort studies were included; RCTs showed no significant difference in surgical success between partial and complete fundoplication (OR 1.33 [0.67, 2.66]).
- Cohort studies exhibited heterogeneity, with limited objective surgical assessment; one study suggested better outcomes with complete fundoplication.
- Common complications included dysphagia and gas-bloat syndrome; overall study quality was poor.
Conclusions:
- Current evidence is insufficient to demonstrate the superiority of either partial or complete fundoplication for GERD.
- Further high-quality randomized controlled trials are necessary to definitively compare these surgical approaches.
- Methodological limitations and heterogeneity in existing studies hinder robust meta-analysis and definitive conclusions.
Background:
There is no consensus as to what extent of "wrap" is required in a fundoplication for correction of gastroesophageal reflux disease (GERD).
Objective:
To evaluate if a complete (360 degree) or partial fundoplication gives better control of GERD.
Methods:
A systematic search of MEDLINE and Scopus identified interventional and observational studies of fundoplication in children. Screening identified those comparing techniques. The primary outcome was recurrence of GERD following surgery. Dysphagia and complications were secondary outcomes of interest. Meta-analysis was performed when appropriate. Study quality was assessed using the Cochrane Risk of Bias Tool.
Results:
2289 abstracts were screened, yielding 2 randomized controlled trials (RCTs) and 12 retrospective cohort studies. The RCTs were pooled. There was no difference in surgical success between partial and complete fundoplication, OR 1.33 [0.67,2.66]. In the 12 cohort studies, 3 (25%) used an objective assessment of the surgery, one of which showed improved outcomes with complete fundoplication. Twenty-five different complications were reported; common were dysphagia and gas-bloat syndrome. Overall study quality was poor.
Conclusions:
The comparison of partial fundoplication with complete fundoplication warrants further study. The evidence does not demonstrate superiority of one technique. The lack of high quality RCTs and the methodological heterogeneity of observational studies limits a powerful meta-analysis.
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