• David I Watson, Glyn G Jamieson, Carolyn Lally, Stephen Archer, Justin R Bessell, Michael Booth, Richard Cade, Graham Cullingford, Peter G Devitt, David R Fletcher, James Hurley, George Kiroff, Christopher J Martin, Ian J G Martin, Leslie K Nathanson, John A Windsor, and International Society for Diseases of the Esophagus--Australasian Section.
• Department of Surgery,k Flinders University of South Australia, Adelaide, Australia. david.watson@flinders.edu.au
• Arch Surg Chicago. 2004 Nov 1; 139 (11): 1160-7.

HypothesisLaparoscopic anterior 90 degrees partial fundoplication for gastroesophageal reflux is associated with a lower incidence of postoperative dysphagia and other adverse effects compared with laparoscopic Nissen fundoplication.DesignA multicenter, prospective, double-blind, randomized controlled trial.SettingNine university teaching hospitals in 6 major cities in Australia and New Zealand.ParticipantsOne hundred twelve patients with proven gastroesophageal reflux disease presenting for laparoscopic fundoplication were randomized to undergo either a Nissen (52 patients) or an anterior 90 degrees partial procedure (60 patients). Patients with esophageal motility disorders, patients requiring a concurrent abdominal procedure, and patients who had undergone previous antireflux surgery were excluded from this study.InterventionsLaparoscopic Nissen fundoplication with division of the short gastric vessels or laparoscopic anterior 90 degrees partial fundoplication.Main Outcome MeasuresIndependent assessment of dysphagia, heartburn, and overall satisfaction 1, 3, and 6 months after surgery using multiple clinical grading systems. Objective measurement of esophageal manometric parameters, esophageal acid exposure, and endoscopic assessment.ResultsPostoperative dysphagia, and wind-related adverse effects were less common after a laparoscopic anterior 90 degrees partial fundoplication. Relief of heartburn was better following laparoscopic Nissen fundoplication. Overall satisfaction was better after anterior 90 degrees partial fundoplication. Lower esophageal sphincter pressure, acid exposure, and endoscopy findings were similar for both procedures.ConclusionsAt the 6-month follow-up, laparoscopic anterior 90 degrees culine partial fundoplication is followed by fewer adverse effects than laparoscopic Nissen fundoplication with full fundal mobilization, and it achieves a higher rate of satisfaction with the overall outcome. However, this is offset to some extent by a greater likelihood of recurrent gastroesophageal reflux symptoms.

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