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Update: total versus partial laparoscopic fundoplication

A Watson1

  • 1University Department of Surgery, Royal Free Hospital School of Medicine, London, UK.

Digestive Surgery
|December 9, 1998
PubMed
Summary
This summary is machine-generated.

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Partial fundoplication offers effective reflux control with fewer mechanical complications than Nissen fundoplication, especially in laparoscopic surgery. This tailored approach is supported by growing evidence and ongoing trials.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Reflux Management

Background:

  • Nissen fundoplication, introduced in 1956, has mechanical complication rates around 15%, linked to a high-pressure zone (HPZ) that inadequately relaxes.
  • Partial fundoplication aims to reduce complications by augmenting valvuloplasty with less extensive fundoplication, though concerns about reflux control efficacy exist.

Purpose of the Study:

  • To compare the efficacy and safety of partial fundoplication versus Nissen fundoplication, particularly in the laparoscopic era.
  • To evaluate the impact of surgical approach (laparoscopic vs. open) on mechanical complications and reflux control.

Main Methods:

  • Review of comparative studies and prospective randomized trials comparing partial and Nissen fundoplication.
  • Analysis of data on mechanical complications, HPZ relaxation, re-operation rates, and reflux control durability.

Related Experiment Videos

Main Results:

  • Partial fundoplication demonstrates comparable or superior reflux control to Nissen fundoplication with significantly fewer mechanical complications.
  • Laparoscopic Nissen fundoplication shows increased mechanical complications and impaired HPZ relaxation compared to open approaches.
  • Laparoscopic partial fundoplication maintains low complication rates and physiological HPZ relaxation, with negligible re-operation rates.

Conclusions:

  • Partial fundoplication is an effective and durable anti-reflux procedure with a lower complication profile, supporting a 'tailored' surgical approach.
  • Ongoing randomized trials are crucial for solidifying the evidence base for optimal laparoscopic anti-reflux surgery selection.