Clinical Outcomes of a Laparoscopic Total vs a 270 degrees Posterior Partial Fundoplication in Chronic Gastroesophageal Reflux Disease: A Randomized Clinical Trial

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Analatos, ApostolosUppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogsvag 1, S-61139 Nyköping, Sweden (författare)

Clinical Outcomes of a Laparoscopic Total vs a 270 degrees Posterior Partial Fundoplication in Chronic Gastroesophageal Reflux Disease : A Randomized Clinical Trial

Artikel/kapitelEngelska2022

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American Medical Association (AMA),2022
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LIBRIS-ID:oai:DiVA.org:uu-485608
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-485608URI
https://doi.org/10.1001/jamasurg.2022.0805DOI

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Importance The efficacy of fundoplication operations in the management of gastroesophageal reflux disease (GERD) has been documented. However, few prospective, controlled series report long-term (>10 years) efficacy and postfundoplication concerns, particularly when comparing various types of fundoplication.Objective To compare long-term (>15 years) results regarding mechanical complications, reflux control, and quality of life between patients undergoing posterior partial fundoplication (PF) or total fundoplication (TF) (270 degrees vs 360 degrees) in surgical treatment for GERD.Design, setting and participants A double-blind randomized clinical trial was performed at a single center (Ersta Hospital, Stockholm, Sweden) from November 19, 2001, to January 24, 2006. A total of 456 patients were recruited and randomized. Data for this analysis were collected from August 1, 2019, to January 31, 2021.Interventions Laparoscopic 270 degrees posterior PF vs 360 degrees TF.Main Outcomes and Measures The main outcome was dysphagia scores for solid and liquid food items after more than 15 years. Generic (36-Item Short-Form Health Survey) and disease-specific (Gastrointestinal Symptom Rating Scale) quality of life and proton pump inhibitor consumption were also assessed.Results Among 407 available patients, relevant data were obtained from 310 (response rate, 76%; mean [SD] age, 66 [11.2] years; 184 [59%] men). A total of 159 were allocated to a PF and 151 to a TF. The mean (SD) follow-up time was 16 (1.3) years. At 15 years after surgery, mean (SD) dysphagia scores were low for both liquids (PF, 1.2 [0.5]; TF, 1.2 [0.5]; P = .58) and solids (PF, 1.3 [0.6]; TF, 1.3 [0.5]; P = .97), without statistically significant differences between the groups. Reflux symptoms were equally well controlled by the 2 types of fundoplications as were the improvements of quality-of-life scores.Conclusions and Relevance The long-term findings of this randomized clinical trial indicate that PF and TF are equally effective for controlling GERD and quality of life in the long term. Although PF was superior in the first years after surgery in terms of less dysphagia recorded, this difference did not prevail when assessed a decade later.

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Hakanson, Bengt S.Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Ersta Hosp, Dept Surg & Anaesthesiol, Stockholm, Sweden (författare)
Ansorge, ChristophKarolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Nyköping Hosp, Dept Surg, Olrogsvag 1, S-61139 Nyköping, Sweden (författare)
Lindblad, MatsKarolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Upper Abdominal Surg, Stockholm, Sweden (författare)
Lundell, LarsKarolinska Inst, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden.;Odense Univ Hosp, Dept Surg, Odense, Denmark (författare)
Thorell, AndersDanderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden (författare)
Uppsala universitetCentrum för klinisk forskning i Sörmland (CKFD) (creator_code:org_t)

Sammanhörande titlar

Ingår i:JAMA Surgery: American Medical Association (AMA)157:6, s. 473-4802168-62542168-6262

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Av författaren/redakt...: Analatos, Aposto ...; Hakanson, Bengt ...; Ansorge, Christo ...; Lindblad, Mats; Lundell, Lars; Thorell, Anders

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Gastroenterologi

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Av lärosätet: Uppsala universitet

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