A meta-analysis of outcomes after open and laparoscopic Nissen's fundoplication in the treatment for gastro-oesophageal reflux disease
BACKGROUND: A meta-analysis of published literature comparing peri-operative, short-term and long-term outcomes after open Nissen's fundoplication (ONF) versus laparoscopic Nissen fundoplication (LNF) for gastro-oesophageal reflux disease. METHODS: Electronic databases were searched from January 1991 to October 2009. A systematic review was performed to obtain a summative outcome. RESULTS: Nine randomized controlled trials involving 657 patients were analysed. Three hundred and thirty-six patients were in the laparoscopic and 321 in the open groups. LNF took longer to perform compared with ONF [random effects model: SMD = -1.64, 95% CI (-2.21, -1.06), z = -5.57, df = 8, p < 0.0001]. Patients undergoing LNF stayed in hospital for less time [random effects model: SMD = 1.19, 95% CI (0.74, 1.65), z = -5.14, df = 8, p < 0.0001] and returned to work sooner [random effects model: SMD = 1.23, 95% CI (0.37, 2.09), z = 2.81, df = 5, p < 0.01]. No difference was seen for morbidity or mortality. Symptomatic outcomes after LNF were comparable to ONF in the short and long terms. LNF fared slightly worse than ONF at 6 months in relation to dysphagia; however, this difference disappeared at 12 months follow-up. CONCLUSIONS: Laparoscopic Nissen's fundoplication is safe, effective and has shorter hospital stays and is associated with an earlier return to work. LNF is comparable to ONF for symptoms and has a high patient satisfaction rate. This approach may be considered as a first line operative technique; however, further follow-up trials focusing on 6-month outcomes are required to strengthen the evidence.