- In surgical treatment for GERD, partial fundal duplication (PF) might be better than total fundal duplication (TF) for inducing less dysphagia.
- Otherwise, either could be recommended based on the results of this randomized clinical trial with 5 years of follow-up.
Why this matters
- Surgical repair can restore a competent esophagogastric junction, but some adverse effects are almost a given.
- Editorial: this “important study” confirms the efficacy of posterior PF and establishes either approach as having “a place in the armamentarium.”
- At 3 years postop, esophageal acid exposure dropped (interquartile ranges):
- PF: from 14.6% (9.8%-21.9%) to 1.8% (0.7%-4.4%).
- TF: from 16.0% (10.4%-22.7%) to 2.5% (0.8%-6.8%).
- Dysphagia during first 6 weeks postop was common but normalized.
- PF slightly favored for dysphagia scores at 6 weeks (P=.01).
- Also for solid food at 12 (P<.001>) and 24 months (P=.001).
- 2 conversions to open surgery, both TF.
- PF involved longer operating time, as expected.
- Randomized trial, 229 patients having 270° posterior PF and 227 having 360° Nissen TF.
- Outcome: esophageal acid exposure at 3 years.
- Funding: Stockholm City Council; Erling-Persson Family Foundation.
- No intraoperative bougie used.