Laparoscopic Nissen Fundoplication with or Without Short Gastric Vessel Division: a Meta-analysis

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2011 Nov 2

PMID 22042586

Citations 8

Authors

Kamran Khatri

Muhammad S Sajid

Robert Brodrick

Mirza K Baig

Mazin Sayegh

Krishna K Singh

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of this work is to systematically analyse the prospective randomised controlled trials on laparoscopic Nissen fundoplication (LNF) with and without short gastric vessel division (SGVD) for management of gastro-oesophageal reflux disease (GORD).

Methods: After an extensive literature search, all previous trials on laparoscopic Nissen fundoplication with and without SGVD for management of GORD were assessed. Those meeting study quality criteria were analysed to generate summative data expressed by standardised mean difference (SMD) and risk ratio (RR).

Results: Five randomised controlled trials on 388 patients qualified for the meta-analysis. There were 194 patients in the no-SGVD group and 194 patients in the SGVD group. No-SGVD was associated with shorter operative time and length of stay. In both fixed- and random-effects models, there were no statistically significant differences in laparoscopic to open conversion rate or complications between the two groups. Three trials presented data on 1-year follow-up, with 118 patients in the no-SGVD group and 112 patients in the SGVD group. There was no statistically significant difference in heartburn, dysphagia, regurgitation or gas bloat syndrome between these two groups. Two trials presented data on 10-year follow-up, with 84 patients in the no-SGVD group and 86 patients in the SGVD group. There was no significant difference in heartburn, dysphagia, regurgitation or gas bloat syndrome between these two groups either. There was no heterogeneity between trials.

Conclusions: Based on this review, SGVD in LNF is associated with longer operative time and hospital stay. However, there is no difference in terms of functional outcomes for 1- and 10-year follow-up. Routine use of SGVD may therefore not be necessary in LNF.

Citing Articles

Evidence mapping on how to perform an optimal surgical repair of large hiatal hernias.

Nickel F, Muller P, Cizmic A, Haberle F, Muller M, Billeter A Langenbecks Arch Surg. 2023; 409(1):15.

PMID: 38123861 PMC: 10733223. DOI: 10.1007/s00423-023-03190-y.

Comparison of the outcome of laparoscopic procedures for GERD.

Rebecchi F, Allaix M, Cinti L, Nestorovic M, Morino M Updates Surg. 2018; 70(3):315-321.

PMID: 30027381 DOI: 10.1007/s13304-018-0572-y.

Esophageal Calibration with Soft Orogasrtric Tube During Laparoscopic Nissen Fundoplication may Reduce Postoperative Transient Dysphagia.

Bulbuller N, Oner O Indian J Surg. 2016; 77(Suppl 3):759-63.

PMID: 27011452 PMC: 4775600. DOI: 10.1007/s12262-013-0995-0.

Laparoscopic surgery: A qualified systematic review.

Buia A, Stockhausen F, Hanisch E World J Methodol. 2015; 5(4):238-54.

PMID: 26713285 PMC: 4686422. DOI: 10.5662/wjm.v5.i4.238.

Pain after laparoscopic antireflux surgery.

Bunting D, Szczebiot L, Peyser P Ann R Coll Surg Engl. 2014; 96(2):95-100.

PMID: 24780664 PMC: 4474268. DOI: 10.1308/003588414X13824511649256.

References

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

Stipa S, FEGIZ G, Iascone C, Paolini A, Moraldi A, De Marchi C . Belsey and Nissen operations for gastroesophageal reflux. Ann Surg. 1989; 210(5):583-9. PMC: 1357790. DOI: 10.1097/00000658-198911000-00003. View

DeMeester T, Bonavina L, Albertucci M . Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg. 1986; 204(1):9-20. PMC: 1251217. DOI: 10.1097/00000658-198607000-00002. View

DeMets D . Methods for combining randomized clinical trials: strengths and limitations. Stat Med. 1987; 6(3):341-50. DOI: 10.1002/sim.4780060325. View

Pennathur A, Awais O, Luketich J . Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg. 2010; 89(6):S2159-62. DOI: 10.1016/j.athoracsur.2010.03.069. View

Watson D, Pike G, Baigrie R, Mathew G, Devitt P, Jamieson G . Prospective double-blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg. 1997; 226(5):642-52. PMC: 1191126. DOI: 10.1097/00000658-199711000-00009. View

Yang H, Watson D, Lally C, Devitt P, Game P, Jamieson G . Randomized trial of division versus nondivision of the short gastric vessels during laparoscopic Nissen fundoplication: 10-year outcomes. Ann Surg. 2007; 247(1):38-42. DOI: 10.1097/SLA.0b013e31814a693e. View

Kosek V, Wykypiel H, Weiss H, Holler E, Wetscher G, Margreiter R . Division of the short gastric vessels during laparoscopic Nissen fundoplication: clinical and functional outcome during long-term follow-up in a prospectively randomized trial. Surg Endosc. 2008; 23(10):2208-13. DOI: 10.1007/s00464-008-0267-4. View

Chrysos E, Tzortzinis A, Tsiaoussis J, Athanasakis H, Vasssilakis J, Xynos E . Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for laparoscopic fundoplication. Am J Surg. 2001; 182(3):215-21. DOI: 10.1016/s0002-9610(01)00695-x. View

10.

Ackroyd R, Watson D, Majeed A, Troy G, Treacy P, Stoddard C . Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux disease. Br J Surg. 2004; 91(8):975-82. DOI: 10.1002/bjs.4574. View

11.

Blomqvist A, Dalenback J, Hagedorn C, Lonroth H, Hyltander A, Lundell L . Impact of complete gastric fundus mobilization on outcome after laparoscopic total fundoplication. J Gastrointest Surg. 2000; 4(5):493-500. DOI: 10.1016/s1091-255x(00)80092-x. View

12.

DeMeester T, Stein H . Minimizing the side effects of antireflux surgery. World J Surg. 1992; 16(2):335-6. DOI: 10.1007/BF02071542. View

13.

Vakil N . Review article: the role of surgery in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007; 25(12):1365-72. DOI: 10.1111/j.1365-2036.2007.03333.x. View

14.

Bammer T, Hinder R, Klaus A, Klingler P . Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg. 2001; 5(1):42-8. DOI: 10.1016/s1091-255x(01)80012-3. View

15.

Donahue P, Samelson S, Nyhus L, Bombeck C . The floppy Nissen fundoplication. Effective long-term control of pathologic reflux. Arch Surg. 1985; 120(6):663-8. DOI: 10.1001/archsurg.1985.01390300013002. View

16.

Luostarinen M, Isolauri J, Laitinen J, Koskinen M, KEYRILAINEN O, MARKKULA H . Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis. Gut. 1993; 34(8):1015-20. PMC: 1374345. DOI: 10.1136/gut.34.8.1015. View

17.

Liu J . Endoscopic treatment for gastroesophageal reflux disease: should you learn the techniques?. Can J Gastroenterol. 2007; 21(4):213-5. PMC: 2657692. DOI: 10.1155/2007/812967. View

18.

Mattioli S, Lugaresi M, Pierluigi M, Di Simone M, DOvidio F . Review article: indications for anti-reflux surgery in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2003; 17 Suppl 2:60-7. DOI: 10.1046/j.1365-2036.17.s2.4.x. View

19.

El-Serag H . Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol. 2006; 5(1):17-26. DOI: 10.1016/j.cgh.2006.09.016. View

20.

Salminen P, Hiekkanen H, Rantala A, Ovaska J . Comparison of long-term outcome of laparoscopic and conventional nissen fundoplication: a prospective randomized study with an 11-year follow-up. Ann Surg. 2007; 246(2):201-6. PMC: 1933575. DOI: 10.1097/01.sla.0000263508.53334.af. View