Partial fundoplication may have edge in treating GERD

By David Douglas

NEW YORK (Reuters Health) - 15/3/2019

In surgical treatment of gastroesophageal reflux disease (GERD), partial fundoplication (PF) prompts less dysphagia than total fundoplication (TF), according to randomized trial results reported by Scandinavian researchers.

Dr. Bengt S. Hakanson told Reuters Health by email that the study confirms "no significant differences between PF and TF regarding esophageal acid exposure, typical symptoms of GERD or recurrences."

"Although of relatively low grade," he added, "postoperative dysphagia is less prevalent after PF than after TF, 2 years after surgery, indicating that PF could be used more frequently than today."

As reported March 6 online in JAMA Surgery, Dr. Hakanson of Ersta Hospital, Stockholm, Sweden, and colleagues studied 456 patients who had been randomized to a 270-degree posterior PF or a 360-degree Nissen TF between 2001 and 2012. All underwent surgery at a single center.

At three years, esophageal acid exposure was reduced from 14.6% to 1.8% after PF and from 16.0% to 2.5% after TF. Similarly, reflux symptoms were equally and effectively controlled.

However, a small but statistically significant difference in favor of PF was noted in the mean scoring of dysphagia for liquids at 6 weeks and for solid food at 12 and 24 months.

There were no major differences between groups in the abdominal pain, indigestion, and diarrhea domains of the Gastrointestinal Symptom Rating Scale, suggesting, say the investigators, "that general postfundoplication complaints are of minor clinical relevance."

Dr. Marco G. Patti of the University of North Carolina, Chapel Hill, author of an accompanying editorial, told Reuters Health by email that this is an "important study as it confirms the similar efficacy of 270- and 360-degree fundoplication for the treatment of GERD."

"In the U.S., however," he added, "the 360-degree fundoplication is still the procedure of choice, limiting the use of partial fundoplication to patients who have weak peristalsis or in whom pre-operative manometry was not done."


JAMA Surg 2019.

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