Meta-analysis of laparoscopic posterior and anterior fundoplication for gastro-oesophageal reflux disease

Subramanya, Manjunath S. and Hossain, Md. Belal and Khan, Shahjahan and Memon, Breda and Memon, Muhammed Ashraf (2010) Meta-analysis of laparoscopic posterior and anterior fundoplication for gastro-oesophageal reflux disease. In: 10th Islamic Countries Conference on Statistical Sciences (ICCSS-10): Statistics for Development and Good Governance, 20-23 Dec 2009, Cairo, Egypt.


Objectives: Although laparoscopic posterior (Nissen) fundoplication (LPF) has the proven efficacy for controlling gastro-oesophgeal reflux surgically, there remain problems with postoperative dysphagia and the inability to belch or vomit. To decrease some of these
postoperative complications, laparoscopic anterior fundoplication (LAF) was introduced. The aim of this study was to conduct a meta-analysis of RCTs to investigate the merits of LPF vs LAF for the treatment of gastro-oesophageal reflux disease (GORD).
Data Sources and Review Methods: A search of Medline, Embase, Science Citation Index, Current Contents, PubMed and the Cochrane Database identified all RCTs comparing different types of laparoscopic posterior and anterior fundoplications published in the English Language
between 1990 and 2008. The eight variables analysed included operative time, overall complications, rate of conversion to open, re-do operative rate, dysphagia score, heartburn rate, visick grading of satisfaction and overall satisfaction.
Results: Five trials totalling 556 patients (Posterior=277, Anterior=279) were analysed. The analysis showed trends favouring LPF in terms of overall complication rate, conversion rate, incidence of postoperative heartburn and re-do operative rate. There was significant improvement in the postoperative satisfaction score in terms of reflux symptoms favouring LPF while there was significant reduction in the dysphagia score favouring LAF. No difference was noted in operating time and Visick's grading of satisfaction between the two groups.
Conclusions: Based on this meta analysis, LPF is associated with fewer complications, decreased rate of conversion, heartburn rate, re-operation rate and significantly higher overall satisfaction rate for controlling GORD symptoms. However the LAF was associated with a significantly lower incidence of dysphagia compared to its posterior counterpart. We therefore conclude that LPF is a better alternative to AFP at the expense of higher dysphagia rate.

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Item Type: Conference or Workshop Item (Commonwealth Reporting Category E) (Paper)
Refereed: Yes
Item Status: Live Archive
Additional Information: Permanent restricted access to published version due to publisher copyright policy.
Faculty / Department / School: Historic - Faculty of Sciences - Department of Maths and Computing
Date Deposited: 27 Jan 2011 06:36
Last Modified: 02 May 2017 06:17
Uncontrolled Keywords: fundoplication; anti-reflux; posterior fundoplication; Nissen fundoplication; anterior antireflux surgery; gastro-oesophagael reflux disease; randomised controlled trials
Fields of Research : 11 Medical and Health Sciences > 1103 Clinical Sciences > 110307 Gastroenterology and Hepatology
11 Medical and Health Sciences > 1103 Clinical Sciences > 110323 Surgery
11 Medical and Health Sciences > 1117 Public Health and Health Services > 111717 Primary Health Care
Socio-Economic Objective: C Society > 92 Health > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures

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