Fundoplication significantly improves objective and subjective reflux outcomes-a meta-analysis

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Device Technology

Background:

• Gastroesophageal reflux disease (GERD) affects 10-30% of Western populations.
• Surgical options like Laparoscopic Fundoplication (LF), Transoral Incisionless Fundoplication (TIF), and Magnetic Sphincter Augmentation (MSA) are effective GERD treatments.

Purpose of the Study:

• To compare short- and long-term outcomes of LF, TIF, and MSA for GERD management.
• To evaluate objective and subjective improvements across different surgical anti-reflux procedures.

Main Methods:

• Meta-analysis of randomized controlled trials and cohort studies (1980-2024).
• Inclusion of studies on Nissen fundoplication, Toupet fundoplication, MSA, and TIF in adult GERD patients.
• Analysis of preoperative and postoperative acid exposure time, DeMeester score, and relief scores using multilevel random-effects meta-analysis and meta-regression.

Main Results:

• All procedures showed significant improvement in acid exposure time, relief scores, and DeMeester scores.
• Nissen fundoplication demonstrated superior improvement in acid exposure time and DeMeester score compared to MSA and TIF.
• Toupet fundoplication and MSA showed significantly better symptom relief scores compared to other surgical options.

Conclusions:

• Nissen fundoplication offers better objective control of GERD parameters.
• Toupet fundoplication and MSA provide superior subjective symptom relief for GERD patients.
• The choice of surgical intervention should consider both objective measures and patient-reported symptom improvement.