Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2019; 25(48): 6876-6879
Published online Dec 28, 2019. doi: 10.3748/wjg.v25.i48.6876
Wrap choice during fundoplication
Simon R Bramhall, Moustafa M Mourad
Simon R Bramhall, Department of Surgery, The County Hospital, Hereford HR1 2ER, United Kingdom
Moustafa M Mourad, Department of Surgery, Worcester Royal Infirmary, Worcester WR5 1DD, United Kingdom
Author contributions: Bramhall SR and Mourad MM contributed to concept of manuscript, manuscript review, accuracy check; Bramhall SR wrote the manuscript.
Conflict-of-interest statement: Neither Dr. Bramhall or Dr. Mourad has nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Simon R Bramhall, MD, FRCS (Gen Surg), Attending Doctor, Surgeon, Department of Surgery, The County Hospital, Union Walk, Hereford HR1 2ER, United Kingdom. simon.bramhall@wvt.nhs.uk
Received: October 21, 2019
Peer-review started: October 21, 2019
First decision: November 26, 2019
Revised: December 3, 2019
Accepted: December 22, 2019
Article in press: December 22, 2019
Published online: December 28, 2019

Gastro-oesphageal reflux disease is an increasing health burden. The mainstay of treatment has conventionally been medical therapy but since the introduction of laparoscopic surgery laparoscopic anti-reflux surgery has been increasingly used for intractable symptoms or in patients unwilling to take long term medication. The Nissen 360 degree wrap has traditionally been considered the gold standard operation but can be associated with significant complications. These complications include “gas bloat” and dysphagia and can occur relatively frequently. Various modifications have been described to the original operation and some of these have been described. In addition alternative wraps have been described which seem to have a reduced incidence of complications associated with their use. This editorial discusses the various types of wrap that can be performed and the minimum requirements of the surgical technique. The evidence from a recent meta-analysis of the randomised data has suggested that an anterior wrap is associated with a lower rate of complications and gives just as good control of reflux symptoms. The advantages and disadvantages of an anterior wrap are discussed. The lack of long term follow up data concerns some practitioners and at the moment the choice of wrap carried out still rests with the individual surgeon.

Keywords: Fundoplication, Wrap, Laparoscopic, Reflux disease, Choice

Core tip: The type of wrap chosen during a laparoscopic fundoplication will be decided by the surgeon but the evidence suggests that an anterior wrap is associated with less complications than a full posterior wrap and gives just as good control of reflux.