Philip Chiu, MD1, Vivien Wong, FRCSEd1, Anthony Teoh, FRCSEd1, Justin Wu, MD2, Hon Chi Yip, FRCSEd1, Shannon Chan, FRCSEd1, Shirley Liu, FRCSEd1, Simon Wong, FRCSEd1, Enders Ng, FRCSEd1. 1Department of Surgery, Chinese University of Hong Kong, 2Department of Medicine, Chinese University of Hong Kong
Background: This is a prospective randomized trial comparing laparoscopic Nissen against anterior partial fundoplication for treatment of GERD in Chinese.
Method: Patients with typical symptoms and either erosive esophagitis or excessive acid exposure were recruited. Patients were randomized to laparoscopic Nissen fundoplication (LNF) or anterior fundoplication (LAF) after repair of crural defect. The demographics, perioperative and clinical outcomes were compared.
Results: From 2007 to 2016, 71 Chinese patients received either LNF (n = 36) or LAF (n = 35). There was no difference in preoperative DeMeester score (LNF 20.9 vs LAF 22.0; p = 0.842), as well as postoperative complication and hospital stay (LNF 2 (1-6) vs LAF 2 (1-12); p = 0.526). There was significantly higher postoperative dysphagia for LNF group (41.7% vs 20%; p = 0.048), while there was no difference in GERD recurrence (11.1% vs 17.1%; p = 0.733).
Conclusion: In Chinese with severe GERD, laparoscopic anterior fundoplication achieved similar effect compared to Nissen. Anterior fundoplication is associated with lower rate of dysphagia (NCT00480285).
| Parameters | LNF (36) | LAF (35) | p value |
| Age (yrs) | 52 (28-70) | 52 (21-65) | 0.549 |
| Gender (Male)(%) | 22 (61.1) | 25 (71.4) | 0.358 |
| Duration of GERD (months) | 60 (12-120) | 48 (10-180) | 0.912 |
| No of comorbidities | 1 (0-4) | 1 (0-5) | 0.242 |
| Preop DeMeester score | 20.9 +/- 21.6 | 22.0 +/- 22.2 | 0.842 |
| Operative time (mins) | 100 (45-225) | 105 (40-165) | 0.787 |
| Fundoplication time (mins) | 30 (12-100) | 42.5 (15-90) | 0.001 |
| Hospital stay (days) | 4 (2-8) | 4 (2-8) | 0.747 |
| Postop complication (%) | 2 (5.6) | 3 (8.6) | 0.674 |
| 30 Days mortality | 0 | 0 | – |
| Days to resume diet | 2 (1-4) | 2 (1-5) | 0.992 |
| Overall postop dysphagia (%) | 15 (41.7) | 7 (20) | 0.048 |
| Reoperation (%) | 2 (5.6) | 1 (2.9) | 1.0 |
| Endoscopic dilatation (%) | 5 (13.9) | 1 (2.9) | 0.199 |
| Recurrence of GERD (%) | 4 (11.1) | 6 (17.1) | 0.733 |
| Postop DeMeester score at 12 months | 0.3 (0-59.5) | 0.3 (0-45.9) | 0.326 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86683
Program Number: P394
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster