Systematic review: Laparoscopic fundoplication for gastroesophageal reflux disease in partial responders to proton pump inhibitors

Table 1 Details of selected studies

Ref.	Study design	Country	Definition of partial response	Age range (yr)	n
Bais et al[7] Draaisma et al[8] Broeders et al[9]	RCT 10-yr follow-up of LNF vs CNF	Netherlands	Bais et al: "…in patients with symptoms of GORD, insufficiently reacting to at least 40 mg of omeprazole daily, persisting oesophagitis, and pathological acid exposure, surgical treatment was proposed"… Broeders et al: "177 patients were included in a multi-center RCT to undergo Nissen fundoplication for PPI-refractory GERD"	17-79	79
Granderath et al[10]	Prospective 5-yr follow-up of LTF	Austria	"All patients had a long history of GERD symptoms (mean 7.1 years; range 6 mo to more than 10 yr) and had been receiving medical treatment with PPI for a mean period of 18.4 ± 6.8 mo (20-60 mg omeprazole daily)"	29-74	155
Anvari et al[11]	Prospective 5-yr follow-up of LF (one cohort of “poor responders”)	Canada	"Inadequate response (< 70% relief on a visual analogue scale, defined by the patient's subjective impression) to PPIs titrated to a dose of 120 mg/d in 445 patients"	Not specified	445
Jenkinson et al[12]	Prospective 6-8-wk follow-up after LF	United Kingdom	"All patients were on long term acid-suppression therapy (at least 4 mo) with PPIs and were either symptomatic or dissatisfied with the treatment"	20-78	70
Mahon et al[13] Mehta et al[14]	RCT 7-yr follow-up of LF vs PPI in GERD (PR subset)	United Kingdom	Mehta et al: "patients with symptoms of GERD for at least 6 mo" with "3 mo minimum of PPI maintenance therapy"..."After 12 mo, those who had been randomized to PPI were offered the opportunity to have surgery"	26-69	54
Pessaux et al[15]	Retrospective 5-yr follow-up of LF	France	"The indications for surgery were intractable or recurrent symptoms due to GERD after an adequate trial (minimum of 3 mo) of conservative treatment that consisted of proton pump inhibitors (n = 1234; 92.1%)"	18-86	1340
Ciovica et al[16]	Prospective 12-mo follow-up of LF	Austria	"Antireflux surgery was indicated and performed in patients with persistent or recurrent GERD symptoms and/or complications despite maximal conservative treatment, and in patients preferring surgery to medical treatment"	16-81	351
Dallemagne et al[17]	Prospective 5- and 10-yr follow-up of LF questionnaires	Belgium	"All patients were taking PPIs for acid suppression" … "For all patients, the primary symptoms indicating surgery were heartburn, associated with regurgitation in 54% and dysphagia in 8% of the patients"	10-78	100
Draaisma et al[18]	RCT 6-mo follow-up of robot-assisted vs standard laparoscopy LF	Netherlands	"Surgical treatment was proposed for patients with GORD insufficiently reacting to proton pump inhibitors..."	20-74	50
Zehetner et al[19]	Prospective 5-yr follow-up of LTF	Switzerland	All patients diagnosed with GERD according to SAGES criteria; "98% received a pre-operative medical treatment for > 3 mo with PPI/H2-blockers and/or prokinetic"	27-81	100
Antoniou et al[20]	Prospective 1-yr follow-up of LNF	Greece	“Continuous doses of PPIs for a minimum period of 6 mo incurred no or only partial relief of their symptoms. More specifically, refractory GERD symptoms to a standard dose of PPIs (omeprazole 20 mg/d) for at least 4 mo were followed by a therapeutic trial with a double dose of PPIs (omeprazole 40 mg/d) for 8-10 wk. Patients not responding to the high-dose PPI treatment were included in the study"	17-65	32
Brillantino et al[21]	Prospective 1-yr follow-up of LNF	Italy	"…patients referred for symptomatic gastroesophageal reflux poorly responsive to standard dose PPI therapy…" "...persisting heartburn or regurgitation during treatment for at least 3 mo with omeprazole at 40 mg or lansoprazole at 30 mg/d…"	18-70	35
Broeders et al[22]	Prospective 1-yr follow-up of LNF	Netherlands	"Thirty-one patients with PPI-refractory GORD with pathological acid exposure on pH monitoring…"	26-67	31
Frazzoni et al[23]	Prospective 3-mo follow-up of EsophyX vs LNF	Italy	"...adult patients referred to our centre because of troublesome heartburn/regurgitation persisting despite at least 4-wk high-dose PPI therapy"	“Adults”	10
				Total:	2852

CNF: Conventional Nissen fundoplication; GERD: Gastroesophageal reflux disease; GORD: Gastro-oesophageal reflux disease; H₂: Histamine-2 receptor; LF: Laparoscopic fundoplication; LNF: Laparoscopic Nissen fundoplication; LTF: Laparoscopic Toupet fundoplication; NA: Not available; PPI: Proton pump inhibitor; PR: Partial responder; RCT: Randomized controlled trial; SAGES: Society of American Gastrointestinal and Endoscopic Surgeons.