LONG-TERM OUTCOMES FOLLOWING DOR, TOUPET, AND NISSEN FUNDOPLICATION: A NETWORK META-ANALYSIS OF RANDOMIZED TRIALS
Yung Lee*1,3, Umair Tahir1, Kevin Yang1, Taaha Hassan1, Yasith Samarasinghe1, Jerry Dang2, Aristithes Doumouras1, Dennis Hong1
1McMaster University, Hamilton, ON, Canada; 2Cleveland Clinic, Cleveland, OH; 3Harvard University T H Chan School of Public Health, Boston, MA
BACKGROUND: In the surgical management of gastroesophageal reflux disease (GERD), the traditional procedure is laparoscopic total (Nissen) fundoplication. However, partial fundoplications have been advocated as providing similar reflux control while potentially minimizing dysphagia. The comparative outcomes of different approaches to fundoplication is a topic of ongoing debate and long-term outcomes remain uncertain. We aim to compare long-term GERD related outcomes following different fundoplication procedures.
METHODS: MEDLINE, EMBASE, PubMed, and CENTRAL databases were searched up to November 2022 to identify randomized controlled trials (RCTs) comparing different types of fundoplications reporting long-term (>5 years) outcomes. The primary outcome was incidence of dysphagia. Secondary outcomes included incidence of heartburn/reflux, regurgitation, inability to belch, abdominal bloating, reoperation, usage of antireflux medications, and patient satisfaction. Python 3.8.3 and R 3.6.2 were used to perform the network meta-analysis. We evaluated the overall certainty of evidence with the GRADE framework.
RESULTS: 14 RCTs were included, with 1349, 257, and 885 cases of Nissen (360°), Dor (anterior 180°-200°), and Toupet (posterior 270°) fundoplications, respectively. Network estimates demonstrated that Toupet had lower incidence of dysphagia compared to Nissen (OR 0.285; 95% CrI 0.06-0.958). There were no differences in dysphagia between Toupet and Dor (OR 0.473, 95% CrI 0.072-2.835) or between Dor and Nissen (OR 1.689, 95% CrI 0.403-7.699). The three fundoplication types were comparable in all other outcomes.
CONCLUSIONS: All three approaches of fundoplication share similar long-term outcomes, with the Toupet fundoplication likely providing the best long-term durability with lowest odds of developing postoperative dysphagia.
Back to 2023 Abstracts