Sophia K McKinley1, Rebecca C Dirks2, Danielle Walsh3, Celeste Hollands4, Lauren E Arthur3, Noe Rodriguez5, Joyce Jhang6, Ahmed Abou-Setta7, Aurora Pryor8, Dimitrios Stefanidis2, Bethany J Slater9. 1. Department of Surgery, Massachusetts General Hospital, Boston, USA. 2. Department of Surgery, Indiana University School of Medicine, Indianapolis, USA. 3. Walsh - Department of Surgery, East Carolina University, Greenville, USA. 4. Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA. 5. Department of Surgery, Florida Atlantic University, Boca Raton, USA. 6. University of Nebraska Medical Center, Omaha, USA. 7. Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada. 8. Department of Surgery, Stony Brook University, Stony Brook, USA. 9. Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4062, Chicago, IL, 606037, USA. bjslater1@gmail.com.
Abstract
BACKGROUND: Gastroesophageal reflux disease (GERD) has a high worldwide prevalence in adults and children. There is uncertainty regarding medical versus surgical therapy and different surgical techniques. This review assessed outcomes of antireflux surgery versus medical management of GERD in adults and children, robotic versus laparoscopic fundoplication, complete versus partial fundoplication, and minimal versus maximal dissection in pediatric patients. METHODS: PubMed, Embase, and Cochrane databases were searched (2004-2019) to identify randomized control and non-randomized comparative studies. Two independent reviewers screened for eligibility. Random effects meta-analysis was performed on comparative data. Study quality was assessed using the Cochrane Risk of Bias and Newcastle Ottawa Scale. RESULTS: From 1473 records, 105 studies were included. Most had high or uncertain risk of bias. Analysis demonstrated that anti-reflux surgery was associated with superior short-term quality of life compared to PPI (Std mean difference = - 0.51, 95%CI - 0.63, - 0.40, I2 = 0%) however short-term symptom control was not significantly superior (RR = 0.75, 95%CI 0.47, 1.21, I2 = 82%). A proportion of patients undergoing operative treatment continue PPI treatment (28%). Robotic and laparoscopic fundoplication outcomes were similar. Compared to total fundoplication, partial fundoplication was associated with higher rates of prolonged PPI usage (RR = 2.06, 95%CI 1.08, 3.94, I2 = 45%). There was no statistically significant difference for long-term symptom control (RR = 0.94, 95%CI 0.85, 1.04, I2 = 53%) or long-term dysphagia (RR = 0.73, 95%CI 0.52, 1.02, I2 = 0%). Ien, minimal dissection during fundoplication was associated with lower reoperation rates than maximal dissection (RR = 0.21, 95%CI 0.06, 0.67). CONCLUSIONS: The available evidence regarding the optimal treatment of GERD often suffers from high risk of bias. Additional high-quality randomized control trials may further inform surgical decision making in the treatment of GERD.
BACKGROUND:Gastroesophageal reflux disease (GERD) has a high worldwide prevalence in adults and children. There is uncertainty regarding medical versus surgical therapy and different surgical techniques. This review assessed outcomes of antireflux surgery versus medical management of GERD in adults and children, robotic versus laparoscopic fundoplication, complete versus partial fundoplication, and minimal versus maximal dissection in pediatric patients. METHODS: PubMed, Embase, and Cochrane databases were searched (2004-2019) to identify randomized control and non-randomized comparative studies. Two independent reviewers screened for eligibility. Random effects meta-analysis was performed on comparative data. Study quality was assessed using the Cochrane Risk of Bias and Newcastle Ottawa Scale. RESULTS: From 1473 records, 105 studies were included. Most had high or uncertain risk of bias. Analysis demonstrated that anti-reflux surgery was associated with superior short-term quality of life compared to PPI (Std mean difference = - 0.51, 95%CI - 0.63, - 0.40, I2 = 0%) however short-term symptom control was not significantly superior (RR = 0.75, 95%CI 0.47, 1.21, I2 = 82%). A proportion of patients undergoing operative treatment continue PPI treatment (28%). Robotic and laparoscopic fundoplication outcomes were similar. Compared to total fundoplication, partial fundoplication was associated with higher rates of prolonged PPI usage (RR = 2.06, 95%CI 1.08, 3.94, I2 = 45%). There was no statistically significant difference for long-term symptom control (RR = 0.94, 95%CI 0.85, 1.04, I2 = 53%) or long-term dysphagia (RR = 0.73, 95%CI 0.52, 1.02, I2 = 0%). Ien, minimal dissection during fundoplication was associated with lower reoperation rates than maximal dissection (RR = 0.21, 95%CI 0.06, 0.67). CONCLUSIONS: The available evidence regarding the optimal treatment of GERD often suffers from high risk of bias. Additional high-quality randomized control trials may further inform surgical decision making in the treatment of GERD.
Authors: Nicholas J Shaheen; Richard A Hansen; Douglas R Morgan; Lisa M Gangarosa; Yehuda Ringel; Michelle T Thiny; Mark W Russo; Robert S Sandler Journal: Am J Gastroenterol Date: 2006-07-18 Impact factor: 10.864
Authors: Afrin N Kamal; Shumon I Dhar; Thomas L Carroll; Lee M Akst; Jonathan M Bock; John O Clarke; Jerome R Lechien; Jacqueline Allen; Peter C Belafsky; Joel H Blumin; Walter W Chan; Ronnie Fass; P Marco Fisichella; Michael Marohn; Ashli K O'Rourke; Gregory Postma; Edoardo V Savarino; Michael F Vaezi Journal: Dig Dis Sci Date: 2022-08-22 Impact factor: 3.487