Laparoscopic Nissen And Toupet Fundoplication In The Treatment Of Gastroesophageal Reflux Disease:A Meta-Analysis And Systematic Review

Objective:Gastroesophageal reflux disease(GERD)is a common digestive disease that is caused by the reflux of gastric acid and stomach contents into the oesophagus and surrounding tissues and organs,resulting in symptoms and complications.Fundoplication is the mainstream approach for surgical treatment of GERD.Laparoscopic Nissen fundoplication(LNF)is a classic surgical method of fundoplication,the laparoscopic Toupet fundoplication(LTF)is a modification of the LNF and is designed to further reduce the incidence of postoperative complications.However,their surgical efficacy is still controversial and a systematic review and meta-analysis of the short and long-term results of randomized controlled trials(RCTs)between LNF and LTF is needed to compare their differences in the treatment of GERD.Methods:In this study,we were searched and manually reviewed through PubMed,Cochrane,Embase,Web of science,CNKI,Wangfang,CBM,VIP,ClinicalTrials.gov and ChiCTR,the RCT studies comparing LNF and LTF that met the criteria were collected.Outcome parameters included postoperative reflux recurrence,postoperative heartburn,postoperative dysphagia,postoperative chest pain,postoperative inability to belch,postoperative gas bloating,satisfaction with intervention,postoperative esophagitis,postoperative DeMeester scores,operating time(min),in-hospital complications,postoperative use of proton pump inhibitors,reoperation rate,postoperative lower oesophageal sphincter(LOS)pressure(mmHg).Two researchers independently conducted literature screening,extracted data,and conducted meta-analysis of the results using Review Manager 5.4.1 software.Results:A total of nine eligible RCTs was included in this study comparing LNF(n=645)and LTF(n=647).There were no significant differences between the LNF and LTF in terms of postoperative reflux recurrence,postoperative heartburn,postoperative chest pain,satisfaction with intervention in short and long term.Gas bloating in long term,esophagitis in short term,postoperative DeMeester scores in long term,and in-hospital complications,postoperative use of proton pump inhibitors in long term,reoperation rate.The LTF group had a slightly longer operative time and a lower long-term postoperative LOS pressure(mmHg).However,short-and long-term postoperative dysphagia,inability to belch and gas bloating in the short term were low incidence in the LTF group,and the differences were statistically significant.Conclusion:Our conclusions are based on the results of meta-analysis,which showed that LTF was as effective as LNF in controlling reflux symptoms and improving quality of life,with a low rate of LTF-related complications.Surgical treatment of LTF is more effective in patients over 16 years of age with classic symptoms of GERD and no history of upper abdominal surgery.