Background: Laparoscopic Nissen fundoplication (LNF) is the most common surgical procedure for the surgical\nmanagement of gastro-esophageal reflux disease (GERD). Laparoscopic Toupet fundoplication (LTF) has been\nreported to have a lower prevalence of postoperative complications yet still obtain a similar level of reflux control.\nWe conducted a meta-analysis to confirm the value of LNF and LTF.\nMethods: PubMed, Medline, Embase, Cochrane Library and Springerlink were searched for randomized controlled\ntrials (RCTs) comparing LNF and LTF. Data regarding the benefits and adverse results of two techniques were\nextracted and compared using a meta-analysis.\nResults: Eight eligible RCTs comparing LNF (n = 625) and LTF (n = 567) were identified. There were no significant\ndifferences between LNF and LTF with regard to hospitalization duration, perioperative complications, patient satisfaction,\npostoperative heartburn, regurgitation, postoperative DeMeester scores, or esophagites. A shorter operative time and\nhigher postoperative lower esophageal sphincter pressure were associated with LNF. Prevalence of postoperative\ndysphagia, gas-bloating, inability to belch, dilatation for dysphagia and reoperation were higher after LNF, but\nsubgroup analyses showed that differences with respect to dysphagia between LNF and LTF disappeared over\ntime. Subgroup analyses did not support ââ?¬Å?tailored therapyââ?¬Â according to preoperative esophageal motility.\nConclusions: LNF and LTF have equivalently good control of GERD and result in a similar prevalence of patient\nsatisfaction. Based on current evidence, it is not rational or advisable to abandon LNF when choosing a surgical\nprocedure for GERD.
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