Comparison of Laparoscopic 270° Posterior Partial Fundoplication vs Total Fundoplication for the Treatment of Gastroesophageal Reflux Disease: A Randomized Clinical Trial
| Autor: | Lars Lundell, Anders Thorell, Bengt Håkanson, Ami Bylund |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Fundoplication 030230 surgery law.invention 03 medical and health sciences Young Adult 0302 clinical medicine Randomized controlled trial Double-Blind Method Interquartile range law Medicine Humans Prospective Studies Young adult Adverse effect Laparoscopy Prospective cohort study Aged medicine.diagnostic_test business.industry Reflux Middle Aged Dysphagia Surgery Treatment Outcome Patient Satisfaction 030220 oncology & carcinogenesis Gastroesophageal Reflux Quality of Life Female medicine.symptom business Deglutition Disorders Follow-Up Studies |
| Zdroj: | Håkanson, B S, Lundell, L, Bylund, A & Thorell, A 2019, ' Comparison of Laparoscopic 270° Posterior Partial Fundoplication vs Total Fundoplication for the Treatment of Gastroesophageal Reflux Disease : A Randomized Clinical Trial ', JAMA Surgery, vol. 154, no. 6, pp. 479-486 . https://doi.org/10.1001/jamasurg.2019.0047 |
| ISSN: | 2168-6262 |
| DOI: | 10.1001/jamasurg.2019.0047 |
| Popis: | Importance: Restoration of the esophagogastric junction competence is critical for effective long-term treatment of gastroesophageal reflux disease. Surgical repair results in such restoration, but mechanical adverse effects seem unavoidable. Minimizing these adverse effects without jeopardizing reflux control is warranted. Objective: To determine whether partial fundoplication (PF) or total fundoplication (TF) is superior in laparoscopic antireflux surgery. Design, Setting, and Participants: In this double-blind, randomized clinical trial of 1171 patients scheduled for laparoscopic antireflux surgery at a single university-affiliated center between November 19, 2001, and January 24, 2006, 456 patients were randomized and followed up for 5 years. Data were collected from November 2001 to April 2012, and data were analyzed from April 2012 to September 2018. Interventions: A 270° posterior PF or a 360° Nissen TF. Main Outcomes and Measures: Esophageal acid exposure at 3 years after surgery. Result: Of the 456 randomized patients, 268 (58.8%) were male, and the mean (SD) age was 49.0 (11.7) years. A total of 229 patients were randomized to PF, and 227 patients were randomized to TF. At 3 years postoperatively, the median (interquartile range) esophageal acid exposure was reduced from 14.6% (9.8-21.9) to 1.8% (0.7-4.4) after PF and from 16.0% (10.4-22.7) to 2.5% (0.8-6.8) after TF (P =.31). Likewise, reflux symptoms were equally and effectively controlled. Early postoperative dysphagia (6 weeks) was common in both groups but then decreased toward normality. A small but statistically significant difference in favor of PF was noted in the mean (SD) scoring of dysphagia for liquids at 6 weeks (PF, 1.6 [0.9]; TF, 1.9 [1.3]; P =.01) and for solid food at 12 months (PF, 1.3 [1.0]; TF, 1.9 [1.4]; P |
| Databáze: | OpenAIRE |
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