Long-term efficacy of total versus posterior partial fundoplication in patients with gastro-oesophageal reflux disease: a systematic review and meta-analysis.

IF 1.1 4区 医学 Q3 SURGERY Annals of the Royal College of Surgeons of England Pub Date : 2024-09-01 Epub Date: 2023-10-16 DOI:10.1308/rcsann.2023.0046
D V Peristeri, H Room, D Tsironis, G Vasilikostas, A Wan
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Abstract

Introduction: Laparoscopic fundoplication remains the standard treatment for patients with severe gastro-oesophageal reflux disease (GORD). Multiple randomised controlled trials (RCTs) have compared the two most commonly performed surgical techniques, total and posterior partial fundoplication (Nissen [NF] and Toupet [TF]), in terms of symptom control and treatment failure in patients without subsequent dysmotility disorders. We aimed to conduct a systematic review and meta-analysis of these two techniques with regard to the long-term effect on reflux control and associated dysphagia.

Methods: The MEDLINE®, Embase®, PubMed® and Cochrane Library databases were searched, and all the relevant published RCTs were shortlisted according to the inclusion criteria. The summated outcomes of long-term results relating to the recurrence of GORD and dysphagia were evaluated in a meta-analysis using RevMan software.

Results: Eight studies (all RCTs) on 1,545 patients undergoing NF or TF were eligible for inclusion in this meta-analysis. There were 799 patients in the NF group and 746 in the TF group. In the random effects model analysis, the incidence of long-term recurrence of GORD was not statistically different between the NF and TF cohorts (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.34-1.41, z=1.01, p=0.31). However, the incidence of long-term dysphagia was statistically lower in the TF group (OR: 2.92, 95% CI: 1.49-5.72, z=3.13, p=0.002) with low between-study heterogeneity (I2=0%).

Conclusions: The findings of this systematic review and meta-analysis on symptomatic GORD appear to be in favour of partial posterior fundoplication (TF) as the optimal treatment. It provides equivalent outcomes in reflux symptom control with a lower risk of postoperative dysphagia compared with total fundoplication (NF).

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胃食管反流病患者完全胃底折叠术与后部胃底折叠手术的长期疗效:一项系统综述和荟萃分析。
引言:腹腔镜胃底折叠术仍然是严重胃食管反流病(GORD)患者的标准治疗方法。多项随机对照试验(RCT)比较了两种最常用的手术技术,即全胃底折叠术和后胃部分折叠术(Nissen[NF]和Toupet[TF]),在症状控制和治疗失败方面,对没有后续运动障碍的患者进行了比较。我们旨在对这两种技术对反流控制和相关吞咽困难的长期影响进行系统综述和荟萃分析。方法:检索MEDLINE®、Embase®、PubMed®和Cochrane Library数据库,并根据纳入标准将所有相关已发表的随机对照试验入围。在一项使用RevMan软件的荟萃分析中评估了与GORD复发和吞咽困难相关的长期结果的汇总结果。结果:对1545名接受NF或TF治疗的患者进行的8项研究(均为随机对照试验)符合纳入该荟萃分析的条件。NF组799例,TF组746例。在随机效应模型分析中,NF和TF队列之间GORD长期复发的发生率没有统计学差异(比值比[OR]:0.69,95%置信区间[CI]:0.34-1.41,z=1.01,p=0.31)。然而,TF组的长期吞咽困难发生率在统计学上较低(OR:2.92,95%CI:1.49-5.72,z=3.13,p=0.002),研究间异质性较低(I2=0%)。结论:这项关于症状性GORD的系统综述和荟萃分析的结果似乎有利于部分后胃底折叠术(TF)作为最佳治疗方法。与全胃底折叠术(NF)相比,它在反流症状控制方面提供了同等的结果,术后吞咽困难的风险更低。
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来源期刊
CiteScore
2.40
自引率
0.00%
发文量
316
期刊介绍: The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November. The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.
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