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Laparoscopic Nissen fundoplication with or without short gastric vessel division: a meta-analysis

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Abstract

Objective

The aim of this work is to systematically analyse the prospective randomised controlled trials on laparoscopic Nissen fundoplication (LNF) with and without short gastric vessel division (SGVD) for management of gastro-oesophageal reflux disease (GORD).

Methods

After an extensive literature search, all previous trials on laparoscopic Nissen fundoplication with and without SGVD for management of GORD were assessed. Those meeting study quality criteria were analysed to generate summative data expressed by standardised mean difference (SMD) and risk ratio (RR).

Results

Five randomised controlled trials on 388 patients qualified for the meta-analysis. There were 194 patients in the no-SGVD group and 194 patients in the SGVD group. No-SGVD was associated with shorter operative time and length of stay. In both fixed- and random-effects models, there were no statistically significant differences in laparoscopic to open conversion rate or complications between the two groups. Three trials presented data on 1-year follow-up, with 118 patients in the no-SGVD group and 112 patients in the SGVD group. There was no statistically significant difference in heartburn, dysphagia, regurgitation or gas bloat syndrome between these two groups. Two trials presented data on 10-year follow-up, with 84 patients in the no-SGVD group and 86 patients in the SGVD group. There was no significant difference in heartburn, dysphagia, regurgitation or gas bloat syndrome between these two groups either. There was no heterogeneity between trials.

Conclusions

Based on this review, SGVD in LNF is associated with longer operative time and hospital stay. However, there is no difference in terms of functional outcomes for 1- and 10-year follow-up. Routine use of SGVD may therefore not be necessary in LNF.

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References

  1. Nissen R (1956) [A simple operation for control of reflux esophagitis]. Schweiz Med Wochenschr 86(S 20):590–592

    PubMed  CAS  Google Scholar 

  2. DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 204:9–20

    Article  PubMed  CAS  Google Scholar 

  3. Stipa S, Fegiz G, Iascone C, Paolini A, Moraldi A, de Marchi C, Chieco PA (1989) Belsey and Nissen operations for gastroesophageal reflux. Ann Surg 210:583–589

    Article  PubMed  CAS  Google Scholar 

  4. Vassilakis JS, Xynos E, Kasapidis P, Chrysos E, Mantides A, Nicolopoulos N (1993) The effect of floppy Nissen fundoplication on oesophageal and gastric motility in gastroesophageal reflux. Surg Gynecol Obstet 177:608–616

    PubMed  CAS  Google Scholar 

  5. Bammer T, Hinder RA, Klaus A, Klingler PJ (2001) Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg 5:42–48

    Article  PubMed  CAS  Google Scholar 

  6. Negre JB (1983) Post-fundoplication symptoms. Do they restrict the success of Nissen fundoplication? Ann Surg 198:698–700

    Article  PubMed  CAS  Google Scholar 

  7. Luostarinen M, Isolauri J, Laitinen J, Koskinen M, Keyriläinen O, Markkula H, Lehtinen E, Uusitalo A (1993) Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis. Gut 34:1015–1020

    Article  PubMed  CAS  Google Scholar 

  8. Perdikis G, Hinder RA, Lund RJ, Raiser F, Katada N (1997) Laparoscopic Nissen fundoplication: where do we stand? Surg Laparosc Endosc 7:17–21

    Article  PubMed  CAS  Google Scholar 

  9. DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients. Ann Surg 204:9–20

    Article  PubMed  CAS  Google Scholar 

  10. Donahue PE, Samelson S, Nyhus LM, Bombeck T (1985) The floppy Nissen fundoplication. Effective long-term control of pathological reflux. Arch Surg 120:663–668

    Article  PubMed  CAS  Google Scholar 

  11. DeMeester TR, Stein HJ (1992) Minimizing the side effects of antireflux surgery. World J Surg 16:335–336

    Article  PubMed  CAS  Google Scholar 

  12. Luostarinen ME, Isolauri JO (1999) Randomized trial to study the effect of fundic mobilization on long-term results of Nissen fundoplication. Br J Surg 86:614–618

    Article  PubMed  CAS  Google Scholar 

  13. Kosek V, Wykypiel H, Weiss H, Holler E, Wetscher G, Margreiter R, Klaus A (2009) division of the short gastric vessels during laparoscopic Nissen fundoplication: clinical and functional outcome during long-term follow-up in a prospectively randomized trial. Surg Endosc 23:2208–2213

    Article  PubMed  Google Scholar 

  14. Farah JF, Grande JC, Goldenberg A, Martinez JC, Lupinacci RA, Matone J (2007) Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation. Acta Cir Bras 22:422–429

    Article  PubMed  Google Scholar 

  15. Chrysos E, Tzortziniz A, Tsiaoussis J, Athanasakis H, Vassilakis J, Xynos E (2001) Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for the laparoscopic fundoplication. Am J Surg 182:215–221

    Article  PubMed  CAS  Google Scholar 

  16. Blomqvist A, Dalenback J, Hagedorn C, Lonroth H, Hyltander A, Lundell L (2000) Impact of complete gastric fundus mobilization on outcome after laparoscopic total fundoplication. J Gastrointest Surg 4:493–500

    Article  PubMed  CAS  Google Scholar 

  17. Watson KI, Pike GK, Baigrie RJ, Matthew G, Devitt PG, Britten-Jones R, Jamieson GG (1997) Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 226:642–652

    Article  PubMed  CAS  Google Scholar 

  18. O’Boyle CJ, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG (2002) Division of short gastric vessels at laparoscopic Nissen fundoplication: a prospective double-blind randomized trial with 5-year follow-up. Ann Surg 235:165–170

    Article  PubMed  Google Scholar 

  19. Mardani J, Lundell L, Lonroth H, Dalenback J, Engstrom C (2009) Ten-year results of a randomized clinical trial of laparoscopic total fundoplication with or without division of the short gastric vessels. Br J Surg 96:61–65

    Article  PubMed  CAS  Google Scholar 

  20. Yang H, Watson DI, Lally cJ, Devitt PG, Game PA, Jamieson GG (2008) Randomized trial of division versus nondivision of the short gastric vessels during laparoscopic Nissen fundoplication: 10-year outcomes. Ann Surg 247:38–42

    Article  PubMed  Google Scholar 

  21. Higgins JPT, Green S (eds) Cochrane Handbook for Systematic Reviews of Intervention Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008, http://www.cochrane-handbook.org

  22. Review Manager (RevMan) [Computer program] (2008) Version 5.0. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen

  23. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  PubMed  CAS  Google Scholar 

  24. DeMets DL (1987) Methods for combining randomized clinical trials: strengths and limitations. Stat Med 6:341–350

    Article  PubMed  CAS  Google Scholar 

  25. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  PubMed  Google Scholar 

  26. El-Serag HB (2007) Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol 5(1):17–26

    Article  PubMed  Google Scholar 

  27. Liu JJ (2007) Endoscopic treatment for gastroesophageal reflux disease: Should you learn the techniques? Can J Gastroenterol 21(4):213–215

    PubMed  Google Scholar 

  28. Mattioli S, Lugaresi ML, Pierluigi M, Di Simone MP, D’Ovidio F (2003) Indications for anti-reflux surgery in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 17(Suppl 2):60–67

    Article  PubMed  Google Scholar 

  29. Vakil N (2007) Review article: the role of surgery in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 25(12):1365–1372

    Article  PubMed  CAS  Google Scholar 

  30. Salminen PTP, Hiekkanen HI, Rantala APT, Ovaska JT (2007) Comparison of long-term outcome of laparoscopic and conventional Nissen fundoplication: a prospective randomized study with an 11-year follow-up. Ann Surg 246(2):201–206

    Article  PubMed  Google Scholar 

  31. Chrysos E, Tsiaoussis J, Athanasakis E, Zoras O, Vassilakis JS, Xynos E (2002) Laparoscopic vs open approach for Nissen fundoplication: a comparative study. Surg Endosc 16(12):1679–1684

    Article  PubMed  CAS  Google Scholar 

  32. Ackroyd R, Watson DI, Majeed AW, Troy G, Treacy PJ, Stoddard CJ (2004) Randomised clinical trial of laparoscopic versus open fundoplication for gastrooesophageal reflux disease. Br J Surg 91(8):975–982

    Article  PubMed  CAS  Google Scholar 

  33. Bais JE, Bartelsman JF, Bonjer HJ, Cuesta MA, Go PM, Klinkenberg-Knol EC, van Lanschot JJ, Nadorp JH, Smout AJ, van der Graaf Y, Gooszen HG (2000) The Netherlands Antireflux Surgery Study Group. Laparoscopic or conventional Nissen fundoplication for gastrooesophageal reflux disease: randomised clinical trial. Lancet 355(9199):170–174

    Article  PubMed  CAS  Google Scholar 

  34. Lundell L (2004) Complications after anti-reflux surgery. Best Pract Res Clin Gastroenterol 18(5):935–945

    PubMed  CAS  Google Scholar 

  35. Pennathur P, Awais O, Luketich JD (2010) Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 89:S2159–S2162

    Article  PubMed  Google Scholar 

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Conflicts of interest

Authors Khatri, Sajid, Brodrick, Baig, Sayegh and Singh have no potential or actual personal, financial or political interest in this study. We also declare that there was no financial support of any person/company in preparation of this study, directly or indirectly.

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Correspondence to Kamran Khatri.

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Khatri, K., Sajid, M.S., Brodrick, R. et al. Laparoscopic Nissen fundoplication with or without short gastric vessel division: a meta-analysis. Surg Endosc 26, 970–978 (2012). https://doi.org/10.1007/s00464-011-1979-4

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  • DOI: https://doi.org/10.1007/s00464-011-1979-4

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