Meta‐analysis of laparoscopic total (Nissen) versus posterior (Toupet) fundoplication for gastro‐oesophageal reflux disease based on randomized clinical trials

Abstract

Laparoscopic Nissen fundoplication (LNF) is the standard procedure for surgical management of gastro-oesophageal reflux disease (GORD). Laparoscopic Toupet fundoplication (LTF) is reported to be as effective as LNF but to be associated with a lower incidence of post-operative dysphagia. This meta-analysis was performed to compare the two techniques with respect to reflux control and associated complications, particularly dysphagia. Pubmed, Medline, Embase and The Cochrane Library were searched. Only randomized controlled trials (RCTs) comparing LNF and LTF were included. Outcomes evaluated were occurrences of heartburn and associated complications (e.g. dysphagia) and degree of patient's satisfaction at early (three to six months) and later (one to three years) post-operative periods. Of 939 patients in seven RCTs, 478 received LNF and 461 received LTF. For both groups, control of reflux was good and occurrence of heartburn were similar. A lower incidence of post-operative dysphagia for both early and later post-operative periods was observed for the LTF group. Patient's satisfaction following either procedure was similar. LNF and LTF are both safe and effective. LTF is truly associated with a lower occurrence of dysphagia. However, LTF is more likely than LNF to be associated with early surgical complications. On the whole, post-surgical satisfaction ratios for the two groups were comparable.