NEW YORK (Reuters Health) - In patients with gastroesophageal reflux disease (GERD), similar outcomes were achieved with posterior partial (PF) or total fundoplication (TF) at the 15-year follow-up to a randomized trial.
"The Nissen fundoplication, which includes a 360 degree wrap around the distal esophagus, has shown excellent results regarding reflux control," Dr. Apostolos Analatos and Dr. Anders Thorell, both of the Karolinska Institutet, in Stockholm, Sweden, told Reuters Health by email. "However, some concern has been raised regarding the side effects that might occur after the procedure."
"Recently," they said, "our team reported 5-year outcomes of a randomized trial showing equally good reflux control with the two procedures, but slightly increased dysphagia for solids in the Nissen group during the first two years after the surgery." (https://bit.ly/3KclwM8)
"The durability of the functional outcomes of these procedures is of great concern, and we therefore performed this study with more than 15 years of follow up," they said.
"Our study did not have sufficient power to perform any sub-analyses of any particular groups of patients," they noted. "It could, however, be speculated that patients with mild esophageal dysmotility might benefit more from a partial fundoplication in order to reduce the risk of mechanical problems. However, this needs to be tested in a larger study that is powered for such analyses."
As reported in JAMA Surgery, Drs. Analatos, Thorell and colleagues compared long-term results on mechanical complications, reflux control, and quality of life in 310 patients (76% response rate; mean age, 66; 59%, men) randomized to PF or TF (270° vs. 360°) for GERD at a single center.
The main outcome was dysphagia scores for solid and liquid foods after more than 15 years. Generic (36-Item Short-Form Health Survey) and disease-specific (Gastrointestinal Symptom Rating Scale) quality of life and proton pump inhibitor consumption were also assessed.
Dysphagia scores improved markedly in both groups at one year after surgery versus before surgery. The improvements were maintained during the entire follow-up period, with only minor changes in the scores. Less dysphagia was reported with PF in the first years after surgery, but the difference faded in subsequent years.
At 15 years, mean dysphagia scores were low in both groups for both liquids (PF, 1.2; TF, 1.2) and solids (PF, 1.3; TF, 1.3), with no statistically significant between-group differences. Reflux symptoms were equally well controlled by both types of fundoplication, and improvement in quality-of-life scores was similar.
Drs. Analatos and Thorell concluded, "Both of these antireflux procedures have good and sustainable results regarding reflux symptoms. However, patients scheduled for a Nissen fundoplication should be informed that there is a slightly higher risk for swallowing difficulties, particularly during the first one or two years after the operation."
SOURCE: https://bit.ly/3LikuiU and https://bit.ly/3KczvBH JAMA Surgery, online April 20, 2022.
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