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Laparoscopic vs. open Nissen's fundoplication for gastro-oesophageal reflux disease in children: A meta-analysis
Peng Zhang1, Jing Tian2, Li Jing3
1Department of Pediatric Surgery, Nanyang Central Hospital, Nanyang, Henan Province, 47300, China.
Insights
Laparoscopic Nissen
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Gastrointestinal Surgery
Background:
- Gastro-oesophageal reflux disease (GERD) in children presents management challenges.
- Existing evidence comparing laparoscopic Nissen's fundoplication (LNF) and open Nissen's fundoplication (ONF) for pediatric GERD is inconsistent.
- This study addresses the need for a clear comparison of LNF and ONF efficacy and safety.
Purpose of the Study:
- To evaluate and compare the efficacy and safety of laparoscopic Nissen's fundoplication (LNF) versus open Nissen's fundoplication (ONF) in pediatric patients with GERD.
- To synthesize evidence from randomized controlled trials (RCTs) to inform clinical decision-making.
- To identify potential risk factors associated with surgical outcomes in pediatric GERD treatment.
Main Methods:
- A systematic literature search was performed to identify relevant randomized controlled trials (RCTs).
- Two independent reviewers selected studies, abstracted data, and assessed methodological quality and evidence levels.
- Data analysis utilized Review Manager Version 5.0, employing risk ratios for dichotomous outcomes and mean differences for continuous outcomes, with heterogeneity assessed using the I-squared statistic.
Main Results:
- Three RCTs involving 171 children were analyzed.
- No significant differences were found between LNF and ONF regarding mortality, postoperative complications, readmission rates, or hospital stay.
- LNF showed a higher incidence of recurrence and longer operative duration but fewer instances of retching compared to ONF.
Conclusions:
- Laparoscopic Nissen's fundoplication (LNF) appears to be as effective and safe as open Nissen's fundoplication (ONF) in the short and long term for pediatric GERD.
- Both surgical approaches carry a significant risk of recurrence and mortality, particularly in specific pediatric subgroups.
- Comprehensive pre-surgical evaluation is crucial for children undergoing fundoplication, especially those with neurological impairment, under 18 months, or of female gender.
Background And Objective:
Available evidence showed inconsistent results between laparoscopic Nissen's fundoplication (LNF) and open Nissen's fundoplication (ONF) for children with gastro-oesophageal reflux disease (GERD), so this study aimed to evaluate the efficacy and safety between LNF and ONF.
Methods:
Systematic, comprehensive literature searches were conducted to include randomized controlled trials (RCTs) that compared LNF and ONF for GERD. Two reviewers independently selected studies, abstracted data and assessed the methodological quality and evidence level. Data was analyzed by Review Manager Version 5.0. Risk ratio (RR) was used for dichotomous outcomes, and mean difference (MD) was used for continuous scales. Heterogeneity was estimated with the I2 statistic, fixed-effect model was used if I2 <50%, and otherwise random-effects model was used.
Results:
Three RCTs (171 children) were included. There was not a statistical difference in mortality (RR 1.12, 95%CI 0.50 2.48), or postoperative complications (RR 0.87, 95%CI 0.61 1.25), readmission (RR 1.53, 95%CI 0.67 3.51), or hospital stay (MD 0.85, 95%CI -0.06 1.75) between LNF and ONF. But LNF was associated with more incidence of recurrence (RR 3.32, 95%CI 1.40 7.84), longer surgery duration (MD 76.33, 95%CI 69.37 83.28), but fewer retching (RR 0.11, 95%CI 0.02 0.58) than ONF.
Conclusions:
LNF might be as effective and safe as ONF in the short and long term, but both were associated with high risk of recurrence and mortality, especially for those children with neurological impairment, before the age of 18 months and female gender. This required a comprehensive evaluation of children before surgery.
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