Brief Article
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Jun 28, 2010; 16(24): 3063-3071
Published online Jun 28, 2010. doi: 10.3748/wjg.v16.i24.3063
Evidence-based appraisal in laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease
Cheng-Xiang Shan, Wei Zhang, Xiang-Min Zheng, Dao-Zhen Jiang, Sheng Liu, Ming Qiu
Cheng-Xiang Shan, Wei Zhang, Xiang-Min Zheng, Dao-Zhen Jiang, Sheng Liu, Ming Qiu, Department of Minimally Invasive Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
Author contributions: Shan CX and Zhang W contributed equally to this work; Shan CX, Zhang W and Qiu M designed the research; Shan CX, Zhang W, Zheng XM, Jiang DZ and Liu S performed the literature search; Shan CX, Zhang W and Jiang DZ conducted trial identification and data extraction; Shan CX and Zhang W performed data integration; Shan CX, Zhang W and Qiu M wrote the paper.
Correspondence to: Ming Qiu, MD, Department of Minimally Invasive Surgery, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai 200003, China. qiuming2006@yahoo.cn
Telephone: +86-21-81885801 Fax: +86-21-63729800
Received: January 20, 2010
Revised: February 20, 2010
Accepted: February 27, 2010
Published online: June 28, 2010
Abstract

AIM: To demonstrate the optimal surgical procedure for gastroesophageal reflux disease.

METHODS: The electronic databases of Medline, Elsevier, Springerlink and Embase over the last 16 years were searched. All clinical trials involved in the outcomes of laparoscopic Nissen fundoplication (LNF) and laparoscopic Toupet fundoplication (LTF) were identified. The data of assessment in benefits and adverse results of LNF and LTF were extracted and compared using meta-analysis.

RESULTS: We ultimately identified a total of 32 references reporting nine randomized controlled trials, eight prospective cohort trials and 15 retrospective trials. These studies reported a total of 6236 patients, of whom 4252 (68.18%) underwent LNF and 1984 (31.82%) underwent LTF. There were no differences between LNF and LTF in patients’ satisfaction, perioperative complications, postoperative heartburn, reflux recurrence and re-operation. Both LNF and LTF enhanced the function of lower esophageal sphincter and improved esophagitis. The postoperative dysphagia, gas-bloating syndrome, inability to belch and the need for dilatation after LNF were more common than after LTF. Subgroup analyses showed that dysphagia after LNF and LTF was similar in patients with normal esophageal peristalsis (EP), but occurred more frequently in patients with weak EP after LNF than after LTF. Furthermore, patients with normal EP after LNF still had a higher risk of developing dysphagia than did patients with abnormal EP after LTF.

CONCLUSION: Compared with LNF, LTF offers equivalent symptom relief and reduces adverse results.

Keywords: Laparoscopic fundoplication; Nissen, Toupet; Gastroesophageal reflux disease; Anti-reflux surgery; Esophageal peristalsis; Meta-analysis