Complications of Laparoscopic Management of GERD. Systematic Review and Meta Analysis

Abstract Background Anti-reflux surgery is an effective alternative to medical treatment of GERD and is the only definitive therapy for the prevention of its severe long-term consequences. For this reason, since its idealization by Nissen, who first described total fundoplication in 1956, it has gained a wide consensus in the international surgical community. Aim of the Study The aim of this study is to detect the types and incidence of postoperative complications after laparoscopic management of GERD. Patients and Methods These studies reported a total of 1791 patients, of whom 941 (52.69 %) underwent laparoscopic partial fundoplication (LPF) either Dor or Toupet and 850 (47.31 %) underwent laparoscopic Nissen fundoplication (LNF). Results There were no statistical differences between LPF and LNF in the perioperative events as operative time and interaoperative complications. This Meta-analysis revealed a significant difference in the late postoperative dysphagia parameter between the two arms of the study, in favour of LPF which has significantly less dysphagia than that recorded with LNF. However, it was found that lower esophageal sphnicter pressure (LESP)(objective parameter of dysphagia) is significantly higher in the group of LNF than that measured in the LPF group, As regard gas related sysmptoms in the form of gas bloating syndrome, ability to relieve bloating and ability to belch. When performing forest plot meta ananlysis for each complication of the gas related symptoms, It was found that there is no statistical difference between LPF and LNF. Also the same results of insignificant difference were obtained when estimating patient's satisfaction. Also, measuring of De meester score that evaluate acid reflux symptoms (objective), it was found that there is no significant difference between the LPF and LNF groups. But when estimating the use of antisecretory drugs (PPIs), this meta-analysis show significant less use of anti secretory drugs among the LNF groups than that the LPF group. Conclusion Both procedure partial and complete wrap are equally effective in controlling reflux symptoms and obtain a comparable prevalence of patient satisfaction. Dysphagia found to be significant after Nissen fundoplication when follow up is 5 years or more. Also there is significant use of antisecretory drugs among the group of partial fundoplication although there is no significant difference in the heart burn symptoms which means that depending on symptoms only is not always the right way of recurrence detection. Also more objective studies are needed to evaluate the clinical outcome and recurrence prior to offering re-visional surgery.