Robert J. Baigrie, University of Cape Town, Cape Town, South Africa

Aim: To compare, at two years, laparoscopic Anterior partial fundoplication and Nissen total fundoplication in a double-blind, randomized, private practice, single surgeon setting outside the USA.

Patients: All patients with proven GORD, regardless of motility.

Primary Outcome measures: dysphagia; abolition of reflux;

Secondary Outcome measures: patient satisfaction at 3, 12, 24 months and revision surgery.

Results: 163 patients (84 Nissen, 79 Anterior) had a median stay of 2 nights, and operation times of 53 vs 59 minutes (ns). Complete follow up was available on 161 patients (99%). Reoperation rate at 90 days was zero. There were no differences in mean heartburn scores (<1/10 at 3, 12, 24 months). Dysphagia scores, using 2 scoring systems, were highly significantly lower after Anterior fundoplication for both liquids (only at 3 months) and solids (3, 12, 24 months). Satisfaction scores (ns) were >9.5/10 at all time points. 4(5%) pts had persistent dysphagia after Nissen, and all underwent successful revision laparoscopic surgery. Ten (12%) had recurrent reflux after Anterior, sufficiently severe in 7(8%) to warrant revision surgery. No patients had recurrent reflux after Nissen. No pts had persistent dysphagia after Anterior. Overall reoperation rate at 2 years was 6%, all achieved laparoscopically.

Conclusion: Nissen cured all patients of reflux, durable to 2 years, but 1:20 required revision. Anterior failed in 12% but avoided dysphagia completely. Patient satisfaction was >9/10 in both groups. Revision laparoscopic surgery, while more difficult, was safe and successful.