No Long-Term Outcome Differences with Partial vs Total Fundoplication for GERD

Aside from dysphagia during the first years after surgery, functional outcomes were similar over the long term for partial compared with total fundoplication, according to study results published online ahead of print in JAMA Surgery.

“The efficacy of fundoplication operations in the management of gastroesophageal reflux disease (GERD) has been documented. However, few prospective, controlled series report long-term (>10 years) efficacy and postfundoplication concerns, particularly when comparing various types of fundoplication,” researchers wrote.

The study focused on patients with chronic GERD at Ersta Hospital, Stockholm, Sweden, who were randomized to either laparoscopic 270° posterior partial fundoplication or 360° total fundoplication surgery between November 19, 2001, and January 24, 2006. Researchers were interested in the differences in mechanical complications, reflux control, and quality of life in the 15 or more years after the procedures.

Among 310 patients with data available for long-term follow-up, 159 underwent partial fundoplication and 151 total fundoplication.

At 15 years after surgery, mean dysphagia scores for liquids and solids were low for both groups, with no significant differences, according to the study. Reflux symptoms were also equally well controlled with either partial or total fundoplication. Quality-of-life gains, too, were similar.

“The long-term findings of this randomized clinical trial indicate that partial fundoplication and total fundoplication are equally effective for controlling GERD and quality of life in the long term,” researchers concluded. “Although partial fundoplication was superior in the first years after surgery in terms of less dysphagia recorded, this difference did not prevail when assessed a decade later.”

—Jolynn Tumolo

Reference

Analatos A, Håkanson BS, Ansorge C, Lindblad M, Lundell L, Thorell A. Clinical outcomes of a laparoscopic total vs a 270° posterior partial fundoplication in chronic gastroesophageal reflux disease: a randomized clinical trial. JAMA Surgery. Published online ahead of print, April 20, 2022.