Both fundoplication surgeries equally effective in improving quality of life of GERD patients

Sweden: In the long run, partial fundoplication (PF) and complete fundoplication (TF) are equally successful at controlling gastroesophageal Reflux disease (GERD) and improving quality of life, says an article published in the Journal of American Medical Association - Surgery.

Fundoplication procedures have been shown to be effective in the treatment of gastroesophageal reflux disease. However, when comparing various forms of fundoplication, there are few prospective, controlled studies that describe long-term (>10 years) effectiveness and post-fundoplication problems. Apostolos Analatos and colleagues conducted this study to compare long-term (>15 years) outcomes in terms of mechanical complications, reflux control, and quality of life between patients who underwent posterior PF or TF in surgical intervention for GERD.

From November 19, 2001, through January 24, 2006, a single site (Ersta Hospital, Stockholm, Sweden) conducted a double-blind randomized clinical study. A total of 456 participants were included in the study and were randomly assigned. The data for this study was gathered between August 1, 2019 and January 31, 2021. The major intervention was a laparoscopic 270° posterior PF vs 360° TF application to the individuals. After more than 15 years, the key outcome was dysphagia ratings for solid and liquid meal items. Quality of life and proton pump inhibitor use was measured both generically (36-Item Short-Form Health Survey) and disease-specifically (Gastrointestinal Symptom Rating Scale).

The key findings of this study were as follows:

• Relevant data were gathered from 310 of the 407 patients that were accessible.
• A total of 159 were assigned to a PF, while 151 were assigned to a TF.
• The average time spent following up was 16 years.
• Mean dysphagia ratings were low for both liquids and solids 15 years following surgery, with no statistically meaningful differences between the groups.
• Both the fundoplications were equally effective in controlling reflux symptoms and improving quality-of-life rankings.

In conclusion, although PF was superior in terms of reduced dysphagia documented in the first year following surgery, this difference did not persist when analyzed a decade later. Nonetheless, this long-term tendency, which has also been documented in population-based studies, is a cause for worry that should be addressed in future research.

Reference: Analatos A, Håkanson BS, Ansorge C, Lindblad M, Lundell L, Thorell A. Clinical Outcomes of a Laparoscopic Total vs a 270° Posterior Partial Fundoplication in Chronic Gastroesophageal Reflux Disease: A Randomized Clinical Trial. JAMA Surg. Published online April 20, 2022. doi:10.1001/jamasurg.2022.0805