Meta-analysis of randomised clinical trials comparing open and laparoscopic anti-reflux surgery

Peters, Matthew James and Mukhtar, Athar and Yunus, Rossita Mohamad and Khan, Shahjahan and Pappalardo, Juanita and Memon, Breda and Memon, Muhammed Ashraf (2009) Meta-analysis of randomised clinical trials comparing open and laparoscopic anti-reflux surgery. American Journal of Gastroenterology, 104 (6). pp. 1548-1561. ISSN 0002-9270

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Abstract

Objective: The aim was to conduct a meta-analysis of the randomised evidence to determine the relative merits of laparoscopic anti-reflux surgery (LARS) and open anti-reflux surgery (OARS) for proven gastro-oesophageal reflux disease. Methodology: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified all randomised clinical trials that compared LARS and OARS and were published in the English language between 1990 and 2007. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement. The six outcome variables analysed were operating time, hospital stay, return to normal activity, perioperative complications, treatment failure and requirement for further surgery. Random effects meta-analyses were performed using odds ratios and weighted mean differences. Results: Twelve trials were considered suitable for the meta-analysis. A total of 503 patients underwent OARS and 533 had LARS. For three of the six outcomes the summary point estimates favoured LARS over OARS. There was a significant reduction of 2.68 days in the duration of hospital stay for the LARS group compared with the OARS group (WMD -2.68, 95% confidence interval (CI) -3.54 to -1.81; P < 0.0001), a significant reduction of 7.75 days in return to normal activity for the LARS group compared with the OARS group (WMD -7.75, 95% CI -14.37 to -1.14; P = 0.0216) and lastly there was a statistically significant reduction of 65% in the relative odds of complication rates for the LARS group compared with the OARS group (OR 0.35, 95% CI 0.16 to 0.75; P = 0.0072). Duration of operating time was significantly longer (39.02 minutes) in the LARS group (WMD 39.02, 95% CI 17.99 to 60.05; P = 0.0003). Treatment failure rates were comparable between the two groups (OR 1.39, 95% CI 0.71 to 2.72; P = 0.3423). Despite this the requirement for further surgery was significantly higher in the LARS group (OR 1.79, 95% CI 1.00 to 3.22; P = 0.05). Conclusions: Based on this meta-analysis, the authors conclude that LARS is an effective and safe alternative to OARS for the treatment of proven gastro-oesophageal reflux disease. LARS enables a faster convalescence and return to productive activity, with a reduced risk of complications and a similar treatment outcome to that of an open approach. However, there is a significantly higher rate of re-operation (79%) in the LARS group.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Authors' version as accepted for publication after peer review deposited in accordance with the coyright policy of the publisher (Nature Publishing) http://www.nature.com/reprints/permission-requests.html Fulltext Reference: Matthew, P., Mukhtar, A., Yunus, R.M., Khan, S., Memon, B., Memon, M.A (2009). Meta analysis of randomized clinical trials comparing open and laparoscopic anti-reflux suergery. American Journal of Gastroenterology, 104: 1548 - 1561.
Depositing User: Professor Shahjahan Khan
Faculty / Department / School: Historic - Faculty of Sciences - Department of Maths and Computing
Date Deposited: 26 Feb 2010 12:34
Last Modified: 11 Nov 2014 02:14
Uncontrolled Keywords: antireflux procedures; laparoscopic method; comparative studies; meta-analysis; randomised controlled trials; patient’s outcome; intraoperative complications; postoperative complications; hospitalization
Fields of Research (FOR2008): 11 Medical and Health Sciences > 1199 Other Medical and Health Sciences > 119999 Medical and Health Sciences not elsewhere classified
11 Medical and Health Sciences > 1103 Clinical Sciences > 110307 Gastroenterology and Hepatology
11 Medical and Health Sciences > 1103 Clinical Sciences > 110323 Surgery
Socio-Economic Objective (SEO2008): C Society > 92 Health > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920105 Digestive System Disorders
C Society > 92 Health > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures
Identification Number or DOI: doi: 10.1038/ajg.2009.176
URI: http://eprints.usq.edu.au/id/eprint/6965

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