137 Does Fundoplication Stand the Test of Time? A Systematic Review of ≥ 10 Years Outcomes Following Minimally Invasive Anti-Reflux Surgery

Abstract Aim Minimally invasive fundoplication(ARS) is the most common surgical treatment for patients with severe gastro-oesophageal reflux disease(GORD) with reported long-term failure rate of 10–15%. Operative failure is usually defined as recurrent reflux and/or dysphagia, which affects the patient’s quality of life. The aim of this study was to perform a systematic literature review of ARS and summarize the evidence for long term safety and efficacy. Method This systematic literature review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data on ARS, without any comparator treatment is presented, with the purpose being to provide updated clinical knowledge with a specific focus on efficacy ≥10years post ARS. MEDLINE, Embase, and the Cochrane Library were searched for randomized controlled trials and non RCTs investigating perioperative and outcomes at follow-up ≥10 years. Results From 977 screened articles, 33 studies (18 RCTs and 15 non-RCT) met the inclusion criteria, comprising 4110 patients. Intraoperative events included bleeding (0.3%), gastroesophageal injury(1.2%), spleen injury(0.6%) and conversion to open (3%). At ≥ 10 years, dysphagia was seen in 21.9%, heartburn/epigastric pain in 27.9%, inability to vomit/belch in 43.8%, and gas bloating (43.5%). 10 years after surgery, reoperation rates were 9.4% and PPI use was 33%. Conclusions The efficacy of fundoplication does decline over time, as demonstrated by PPI usage for recurrent symptoms and an increased reoperation rate representing failures after 10 years. This evidence will help during consent for patients contemplating ARS.