Systematic review and meta-analysis of laparoscopic Nissen (posterior total)versusToupet (posterior partial) fundoplication for gastro-oesophageal reflux disease

作者：Ivo A. M. J. Broeders, F.A. Mauritz, Usama Ahmed Ali, Werner Adriaan Draaisma, Jelle P. H. Ruurda, Hein G. Gooszen, André J.P.M. Smout, Ivo A. M. J. Broeders, Eric J. Hazebroek · 发表于：British journal of surgery · 年份：2010 · DOI：10.1002/bjs.7174 · 被引用次数：300 · 研究领域：Gastroesophageal reflux and treatments、Gastrointestinal motility and disorders、Dysphagia Assessment and Management

BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is currently considered the surgical approach of choice for gastro-oesophageal reflux disease (GORD). Laparoscopic Toupet fundoplication (LTF) has been said to reduce troublesome dysphagia and gas-related symptoms. A systematic review and meta-analysis of randomized clinical trials (RCTs) was performed to compare LNF and LTF. METHODS: Four electronic databases (MEDLINE, Embase, Cochrane Library and ISI Web of Knowledge CPCI-S) were searched and the methodological quality of included trials was evaluated. Outcomes included recurrent pathological acid exposure, oesophagitis, dysphagia, dilatation for dysphagia and reoperation rate. Results were pooled in meta-analyses as risk ratios (RRs) and weighted mean differences. RESULTS: Seven eligible RCTs comparing LNF (n = 404) with LTF (n = 388) were identified. LNF was associated with a significantly higher prevalence of postoperative dysphagia (RR 1.61 (95 per cent confidence interval 1.06 to 2.44); P = 0.02) and dilatation for dysphagia (RR 2.45 (1.06 to 5.68); P = 0.04). There were more surgical reinterventions after LNF (RR 2.19 (1.09 to 4.40); P = 0.03), but no differences regarding recurrent pathological acid exposure (RR 1.26 (0.82 to 1.95); P = 0.29), oesophagitis (RR 1.20 (0.78 to 1.85); P = 0.40), subjective reflux recurrence, patient satisfaction, operating time or in-hospital complications. Inability to belch (RR 2.04 (1.19 to 3.49); P = 0.009) and gas bloating (RR 1.5...