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Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? Systematic review and meta-analysis

DOI: 10.1590/S0004-28032011000400007

Keywords: gastroesophageal reflux, surgery, fundoplication, review, meta-analysis.

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Abstract:

context: although the high incidence of gastroesophageal reflux disease (gerd) in the population, there is much controversy in this topic, especially in the surgical treatment. the decision to use of a total or partial fundoplication in the treatment of gerd is still a challenge to many surgeons because the few evidence found in the literature. objective: to bring more clear evidence in the comparison between total and partial fundoplication. data sources: a systematic review of the literature and metaanalysis with randomized controlled trials accessed from medline, lilacs, cochrane controlled trials database was done. the outcomes remarked were: dysphagia, inability to belch, bloating, recurrence of acid reflux, heartburn and esophagitis. for data analysis the odds ratio was used with corresponding 95% confidence interval. statistical heterogeneity in the results of the metaanalysis was assessed by calculating a test of heterogeneity. the software review manager 5 (cochrane collaboration) was utilized for the data gathered and the statistical analysis. sensitive analysis was applied using only trials that included follow-up over 2 years. results: ten trials were included with 1003 patients: 502 to total fundoplication group and 501 to partial fundoplication group. the outcomes dysphagia and inability to belch had statistical significant difference (p = 0.00001) in favor of partial fundoplication. there was not statistical difference in outcomes related with treatment failure. there were no heterogeneity in the outcomes dysphagia and recurrence of the acid reflux. conclusion: the partial fundoplication has lower incidence of obstructive side effects.

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