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Partial fundoplication (PF) and total fundoplication (TF) are equally effective for maintaining QOL and controlling symptoms of gastroesophageal reflux disease (GERD) after 15 years, according to a study in JAMA Surgery.
Researchers compared the mechanical complications, reflux control, and QOL in patients who received a posterior PF (270°) or TF (360°) for the surgical treatment of GERD after more than 15 years of follow-up.
A total of 456 patients with chronic GERD initially were enrolled in the study (ClinicalTrials.gov Identifier: NCT04182178), of whom 229 were randomly assigned to receive a PF and 227 to receive a TF at a hospital in Stockholm, Sweden, from November 19, 2001, to January 24, 2006. The participants completed the Swedish version of the generic 36-Item Short-Form Health Survey (SF-36), the Gastrointestinal Symptom Rating Scale (GSRS), and a specific dysphagia score questionnaire.
The primary outcome in this long-term follow-up was dysphagia score for solid food and liquid items 15 years postsurgical procedures. Secondary outcomes included QOL, reflux symptoms, proton pump inhibitor (PPI) use, and other operation rates.
The final cohort included 310 patients (mean age, 66±11.2 years; men, 59%) — 159 were originally allocated to a PF and 151 to a TF. The mean follow-up was 16±1.3 years for both groups (P =.64), and the mean age at follow-up was 65±11.0 years in the PF group and 67±11.3 years in the TF group (P =.11).
A statistically significant difference was observed in favor of PF for liquid dysphagia at 1 year postoperation (mean score for PF, 1.0±0.3; TF, 1.1±0.4; P =.04) and for solids at 1 year (mean score for PF, 1.1±0.4; TF, 1.3±0.6; P =.01) and 2 years (mean score for PF, 1.1±0.4; TF, 1.3±0.6; P =.01).
At 15 years postsurgical procedure, the mean dysphagia scores were still low but were now without statistically significant differences in the 2 groups (liquids: mean score for PF, 1.2±0.5; TF, 1.2±0.5; P =.58; solids: mean score for PF, 1.3±0.6; TF, 1.3±0.5; P =.97).
The mean physical component score and mental component score of the SF-36 improved significantly at all follow-up points, with no statistically significant differences found between the 2 treatment groups at 15 years. Also, all scores in the GSRS were low, with no statistically significant differences occurring between the 2 groups. The reflux domain immediately and markedly decreased after surgery and continued throughout the follow-up.
Regarding PPI use, 38 of 159 patients (24%) in the PF group and 42 of 149 patients (28%) in the TF group used PPIs daily at 15 years postsurgical procedure.
Study limitations include the loss of patients during the long-term follow-up, which may have contributed to the observed convergence toward equity between the procedures over time. In addition, the researchers were unable to obtain objective measurements regarding reflux control, such as ambulatory 24-hour pH monitoring.
“Laparoscopic PF and TF led to similar long-term outcomes for dysphagia control and quality of life improvement,” the study authors wrote. “Although PF was superior in the first years after surgery in terms of less dysphagia recorded, this difference did not prevail when assessed a decade later.”
In an accompanying commentary, researchers wrote, “This study provides additional evidence of the long-term equivalence in terms of efficacy of total and 270° partial fundoplication in the treatment of GERD when the surgical technique and key steps are respected.”
Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.
References
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 Surg. 2022;157(6):473-480. doi:10.1001/jamasurg.2022.0805
Dallemagne B, Perretta S. Long-term efficacy of total and partial posterior fundoplication to treat gastroesophageal reflux disease. JAMA Surg. 2022;157(6):480. doi:10.1001/jamasurg.2022.0806
