Laparoscopoc Nissen versus anterior fundoplication in patients with oesophageal dysmotility: a randomized controlled trial

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>It has been postulated that in patients with oesophageal dysmotility a partial fundoplication may be associated with a better outcome than a Nissen fundoplication. This study aimed to compare laparoscopic anterior fundoplication with laparoscopic Nissen fundoplication in patients with disordered peristalsis.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>One hundred and seven patients with documented gastro-oesophageal reflux disease were randomized to undergo either a Nissen fundoplication (n = 53) or an anterior 180° hemifundoplication (n = 54), and were seen at follow-up at least once a year by a blinded investigator who used standardized clinical grading systems to assess postoperative dysphagia, heartburn and patient satisfaction. Patients were divided into two groups depending on preoperative oesophageal manometric findings: normal peristalsis (81 patients) or disordered peristalsis (26 patients – propagated less than 50 per cent of swallows and/or distal peristaltic amplitude less than 40 mmHg).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>At all follow-up intervals beyond 6 months, patients who underwent an anterior fundoplication experienced less dysphagia and were more likely to be satisfied with the clinical outcome. The magnitude of outcome differences was independent of peristaltic status, and there was no trend towards a poorer outcome in patients with poor peristalsis who underwent Nissen fundoplication.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The concept of tailoring the specific antireflux procedure according to preoperative peristaltic status was not supported by this trial. However, laparoscopic anterior fundoplication was associated with less dysphagia overall and an improved clinical outcome at 3 years.</jats:p> </jats:sec>