TY  - JOUR
T1  - FIve-year follow-up of a multicenter, double-blind randomized clinical trial of laparoscopic nissen vs anterior 90° partial fundoplication
AU  - Nijjar RS, Watson DI, Jamieson GG, et al
Y1  - 2010/06/01
N1  - 10.1001/archsurg.2010.81
JO  - Archives of Surgery
SP  - 552
EP  - 557
VL  - 145
IS  - 6
N2  - Hypothesis 
    Laparoscopic 90° anterior partial fundoplication for gastroesophageal reflux disease achieves equivalent results to laparoscopic Nissen fundoplication.Design 
    A multicenter, prospective, double-blind randomized clinical trial with a minimum of 5 years' follow-up.Setting 
    Nine university teaching hospitals in 6 major cities throughout Australia and New Zealand.Participants 
    One hundred twelve patients undergoing primary antireflux surgery were randomized to undergo either laparoscopic Nissen fundoplication (52 patients) or anterior 90° partial fundoplication (60 patients).Interventions 
    Laparoscopic Nissen fundoplication with division of the short gastric vessels or laparoscopic anterior 90° partial fundoplication.Main Outcome Measures 
    Blinded assessment at 1 and 5 years' follow-up of clinical outcome for postoperative heartburn, dysphagia, gas-related symptoms, and satisfaction with the surgical outcome. Analog scales ranging from 0 to 10 were used to assess symptom severity.Results 
    Ninety-seven patients underwent follow-up at 5 years. Three others died during follow-up, 4 refused follow-up, and 8 were lost to follow-up; 89% remained at 5-years' follow-up. At 5 years' follow-up, mean analog scores for heartburn were 2.2 for anterior fundoplication vs 0.9 for Nissen fundoplication (P = .003). There were no significant differences between the groups for dysphagia scores. The mean score for outcome satisfaction was 7.1 after anterior fundoplication vs 8.1 after Nissen fundoplication (P = .18). Eighty-eight percent reported a good or excellent outcome following Nissen fundoplication vs 77% following anterior fundoplication.Conclusions 
    Laparoscopic Nissen and anterior 90° partial fundoplication achieve similar levels of patient satisfaction at 5 years' follow-up, with similar adverse effect profiles. However, at 5 years' follow-up, laparoscopic Nissen fundoplication achieves superior control of reflux symptoms.Trial Registration 
    Australian New Zealand Clinical Trials Register Identifier: ACTRN12607000298415
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2010.81
UR  - http://dx.doi.org/10.1001/archsurg.2010.81
ER  -