A meta-analysis of outcomes after open and laparoscopic Nissen’s fundoplication in the treatment for gastro-oesophageal reflux disease
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : M. R. S. Siddiqui1, Y. Abdulaal2, A.Nisar2, H. Ali2, F. Hasan1
- چاپ و سال / کشور: 2011
Description
Background: A meta-analysis of published literature comparing peri-operative, short-term and longterm outcomes after open Nissen’s fundoplication (ONF) versus laparoscopic Nissen fundoplication (LNF) for gastro-oesophageal reflux disease. Methods: Electronic databases were searched from January 1991 to October 2009. A systematic review was performed to obtain a summative outcome. Results: Nine randomized controlled trials involving 657 patients were analysed. Three hundred and thirty-six patients were in the laparoscopic and 321 in the open groups. LNF took longer to perform compared with ONF [random effects model: SMD¼1.64, 95% CI (2.21, 1.06), z¼5.57, df¼8, p < 0.0001]. Patients undergoing LNF stayed in hospital for less time [random effects model: SMD¼1.19, 95% CI (0.74, 1.65), z¼5.14, df¼8, p < 0.0001] and returned to work sooner [random effects model: SMD¼1.23, 95% CI (0.37, 2.09), z¼2.81, df¼5, p < 0.01]. No difference was seen for morbidity or mortality. Symptomatic outcomes after LNF were comparable to ONF in the short and long terms. LNF fared slightly worse than ONF at 6 months in relation to dysphagia; however, this difference disappeared at 12 months follow-up. Conclusions: Laparoscopic Nissen’s fundoplication is safe, effective and has shorter hospital stays and is associated with an earlier return to work. LNF is comparable to ONF for symptoms and has a high patient satisfaction rate. This approach may be considered as a first line operative technique; however, further follow-up trials focusing on 6-month outcomes are required to strengthen the evidence.
Eur Surg (2011) DOI 10.1007/s10353-011-0003-5 M. R. S. Siddiqui1, Y. Abdulaal2, A.Nisar2, H. Ali2, F. Hasan1
