Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study
Background Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment. Method...
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| Veröffentlicht in: | Surgical endoscopy 2013-03, Vol.27 (3), p.986-991 |
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| creator | Mickevičius, Antanas Endzinas, Žilvinas Kiudelis, Mindaugas Jonaitis, Laimas Kupčinskas, Limas Pundzius, Juozas Maleckas, Almantas |
| description | Background
Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment.
Methods
A total of 153 patients were randomized to Nissen or Toupet 1.5- or 3-cm wrap laparoscopic fundoplication. The primary endpoint—treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up.
Results
At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (
P
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| doi_str_mv | 10.1007/s00464-012-2550-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1288314626</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1288314626</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-16da54eb2fa2db0ab95442d5a9b153b6c204833f66349bb41e6887729ea9656b3</originalsourceid><addsrcrecordid>eNp1kU1rFTEUhoMo9nr1B7iRgBsXHc33zLiTYrVQdFPXIZk5aafMTcZ8VK5b_7gZp4oIbhJCnvfNCQ9Czyl5TQlp3yRChBINoaxhUpKmfYB2VPB6YrR7iHak56RhbS9O0JOUbknFeyofoxPGiWSSqR36ceHdXMAPgIPD36JZ8Az-Ot_g4HG-AQzOwZCnO_CQ0sp8mlICj40f8VUoC2Tsih_DMk-DyVPw6S2WzRFMxBFSmfOv0BJDWraeUxxrNhym7zDilMt4fIoeOTMneHa_79GX8_dXZx-by88fLs7eXTYDb1luqBqNFGCZM2y0xNheCsFGaXpLJbdqYER0nDuluOitFRRU17Ut68H0SirL9-jV1lun-VogZX2Y0gDzbDyEkjRlXcepUExV9OU_6G0o0dfpVqrlHaF13SO6UUP9Xorg9BKng4lHTYleDenNkK6G9GpIr5kX983FHmD8k_itpAJsA1K98tcQ_3r6v60_ARhGnFY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1287380187</pqid></control><display><type>article</type><title>Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Mickevičius, Antanas ; Endzinas, Žilvinas ; Kiudelis, Mindaugas ; Jonaitis, Laimas ; Kupčinskas, Limas ; Pundzius, Juozas ; Maleckas, Almantas</creator><creatorcontrib>Mickevičius, Antanas ; Endzinas, Žilvinas ; Kiudelis, Mindaugas ; Jonaitis, Laimas ; Kupčinskas, Limas ; Pundzius, Juozas ; Maleckas, Almantas</creatorcontrib><description>Background
Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment.
Methods
A total of 153 patients were randomized to Nissen or Toupet 1.5- or 3-cm wrap laparoscopic fundoplication. The primary endpoint—treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up.
Results
At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (
P
< 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis—32.4 %—was found in Toupet 1.5-cm group.
Conclusions
Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-012-2550-7</identifier><identifier>PMID: 23052526</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Barium ; Deglutition Disorders - etiology ; Dysphagia ; Endoscopy ; Esophagitis - etiology ; Esophagus ; Failure ; Female ; Fundoplication - methods ; Gastroenterology ; Gastroesophageal reflux ; Gastroesophageal Reflux - surgery ; Gynecology ; Health sciences ; Heartburn - etiology ; Hepatology ; Hiatal hernias ; Humans ; Laparoscopy ; Laparoscopy - methods ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Normal distribution ; Postoperative Complications - etiology ; Proctology ; Prospective Studies ; Recurrence ; Reoperation ; Surgery ; Treatment Failure ; Young Adult</subject><ispartof>Surgical endoscopy, 2013-03, Vol.27 (3), p.986-991</ispartof><rights>Springer Science+Business Media, LLC 2012</rights><rights>Springer Science+Business Media New York 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-16da54eb2fa2db0ab95442d5a9b153b6c204833f66349bb41e6887729ea9656b3</citedby><cites>FETCH-LOGICAL-c372t-16da54eb2fa2db0ab95442d5a9b153b6c204833f66349bb41e6887729ea9656b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-012-2550-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-012-2550-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23052526$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mickevičius, Antanas</creatorcontrib><creatorcontrib>Endzinas, Žilvinas</creatorcontrib><creatorcontrib>Kiudelis, Mindaugas</creatorcontrib><creatorcontrib>Jonaitis, Laimas</creatorcontrib><creatorcontrib>Kupčinskas, Limas</creatorcontrib><creatorcontrib>Pundzius, Juozas</creatorcontrib><creatorcontrib>Maleckas, Almantas</creatorcontrib><title>Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment.
Methods
A total of 153 patients were randomized to Nissen or Toupet 1.5- or 3-cm wrap laparoscopic fundoplication. The primary endpoint—treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up.
Results
At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (
P
< 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis—32.4 %—was found in Toupet 1.5-cm group.
Conclusions
Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication.</description><subject>Abdominal Surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Barium</subject><subject>Deglutition Disorders - etiology</subject><subject>Dysphagia</subject><subject>Endoscopy</subject><subject>Esophagitis - etiology</subject><subject>Esophagus</subject><subject>Failure</subject><subject>Female</subject><subject>Fundoplication - methods</subject><subject>Gastroenterology</subject><subject>Gastroesophageal reflux</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>Gynecology</subject><subject>Health sciences</subject><subject>Heartburn - etiology</subject><subject>Hepatology</subject><subject>Hiatal hernias</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Normal distribution</subject><subject>Postoperative Complications - etiology</subject><subject>Proctology</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>Reoperation</subject><subject>Surgery</subject><subject>Treatment Failure</subject><subject>Young Adult</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU1rFTEUhoMo9nr1B7iRgBsXHc33zLiTYrVQdFPXIZk5aafMTcZ8VK5b_7gZp4oIbhJCnvfNCQ9Czyl5TQlp3yRChBINoaxhUpKmfYB2VPB6YrR7iHak56RhbS9O0JOUbknFeyofoxPGiWSSqR36ceHdXMAPgIPD36JZ8Az-Ot_g4HG-AQzOwZCnO_CQ0sp8mlICj40f8VUoC2Tsih_DMk-DyVPw6S2WzRFMxBFSmfOv0BJDWraeUxxrNhym7zDilMt4fIoeOTMneHa_79GX8_dXZx-by88fLs7eXTYDb1luqBqNFGCZM2y0xNheCsFGaXpLJbdqYER0nDuluOitFRRU17Ut68H0SirL9-jV1lun-VogZX2Y0gDzbDyEkjRlXcepUExV9OU_6G0o0dfpVqrlHaF13SO6UUP9Xorg9BKng4lHTYleDenNkK6G9GpIr5kX983FHmD8k_itpAJsA1K98tcQ_3r6v60_ARhGnFY</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>Mickevičius, Antanas</creator><creator>Endzinas, Žilvinas</creator><creator>Kiudelis, Mindaugas</creator><creator>Jonaitis, Laimas</creator><creator>Kupčinskas, Limas</creator><creator>Pundzius, Juozas</creator><creator>Maleckas, Almantas</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20130301</creationdate><title>Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study</title><author>Mickevičius, Antanas ; Endzinas, Žilvinas ; Kiudelis, Mindaugas ; Jonaitis, Laimas ; Kupčinskas, Limas ; Pundzius, Juozas ; Maleckas, Almantas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-16da54eb2fa2db0ab95442d5a9b153b6c204833f66349bb41e6887729ea9656b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdominal Surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Barium</topic><topic>Deglutition Disorders - etiology</topic><topic>Dysphagia</topic><topic>Endoscopy</topic><topic>Esophagitis - etiology</topic><topic>Esophagus</topic><topic>Failure</topic><topic>Female</topic><topic>Fundoplication - methods</topic><topic>Gastroenterology</topic><topic>Gastroesophageal reflux</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>Gynecology</topic><topic>Health sciences</topic><topic>Heartburn - etiology</topic><topic>Hepatology</topic><topic>Hiatal hernias</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Normal distribution</topic><topic>Postoperative Complications - etiology</topic><topic>Proctology</topic><topic>Prospective Studies</topic><topic>Recurrence</topic><topic>Reoperation</topic><topic>Surgery</topic><topic>Treatment Failure</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mickevičius, Antanas</creatorcontrib><creatorcontrib>Endzinas, Žilvinas</creatorcontrib><creatorcontrib>Kiudelis, Mindaugas</creatorcontrib><creatorcontrib>Jonaitis, Laimas</creatorcontrib><creatorcontrib>Kupčinskas, Limas</creatorcontrib><creatorcontrib>Pundzius, Juozas</creatorcontrib><creatorcontrib>Maleckas, Almantas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mickevičius, Antanas</au><au>Endzinas, Žilvinas</au><au>Kiudelis, Mindaugas</au><au>Jonaitis, Laimas</au><au>Kupčinskas, Limas</au><au>Pundzius, Juozas</au><au>Maleckas, Almantas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>27</volume><issue>3</issue><spage>986</spage><epage>991</epage><pages>986-991</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment.
Methods
A total of 153 patients were randomized to Nissen or Toupet 1.5- or 3-cm wrap laparoscopic fundoplication. The primary endpoint—treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up.
Results
At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (
P
< 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis—32.4 %—was found in Toupet 1.5-cm group.
Conclusions
Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>23052526</pmid><doi>10.1007/s00464-012-2550-7</doi><tpages>6</tpages></addata></record> |
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| ispartof | Surgical endoscopy, 2013-03, Vol.27 (3), p.986-991 |
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| subjects | Abdominal Surgery Adolescent Adult Aged Aged, 80 and over Barium Deglutition Disorders - etiology Dysphagia Endoscopy Esophagitis - etiology Esophagus Failure Female Fundoplication - methods Gastroenterology Gastroesophageal reflux Gastroesophageal Reflux - surgery Gynecology Health sciences Heartburn - etiology Hepatology Hiatal hernias Humans Laparoscopy Laparoscopy - methods Male Medicine Medicine & Public Health Middle Aged Normal distribution Postoperative Complications - etiology Proctology Prospective Studies Recurrence Reoperation Surgery Treatment Failure Young Adult |
| title | Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study |
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