Skip to main content
SpringerLink
Log in

Update on Fundoplication for the Treatment of GERD

  • Esophagus (MF Vela, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Rudolph Nissen firstly implemented the idea of surgical treatment of gastroesophageal reflux more than 55 years ago. Today, laparoscopic fundoplication has become the surgical “golden standard” for the treatment of GERD. However, the initial enthusiasm and increasing number of performed procedures in the early 1990s declined dramatically between 2000 and 2006. Despite its excellent outcome, laparoscopic fundoplication is only offered to a minority of patients who are suffering from GERD. In this article we review the current indications for antireflux surgery, technical and intraoperative aspects of fundoplication, perioperative complications as well as short and long-term outcome. The focus is on the laparoscopic approach as the current surgical procedure of choice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nissen R. A simple operation for control of reflux esophagitis. Schweiz Med Wochenschr. 1956;86:590–2.

    PubMed  CAS  Google Scholar 

  2. Nissen R. Gastropexy and “fundoplication” in surgical treatment of hiatal hernia. Am J Dig Dis. 1961;6:954–61.

    Article  PubMed  CAS  Google Scholar 

  3. Safaie-Shirazi S, Zike WL, Anuras S, et al. Proceedings: nissen fundoplication without crural repair: a cure for reflux esophagitis. Arch Surg. 1974;108:424–7.

    Article  PubMed  CAS  Google Scholar 

  4. Demeester TR, Johnson LF, Kent AH. Evaluation of current operations for the prevention of gastroesophageal reflux. Ann Surg. 1974;180:511–25.

    Article  PubMed  CAS  Google Scholar 

  5. Brindley Jr GV, Hightower Jr NC. Surgical treatment of gastroesophageal reflux. Surg Clin North Am. 1979;59:841–51.

    PubMed  Google Scholar 

  6. Polk Jr HC, Zeppa R. Hiatal hernia and esophagitis: a survey of indications for operation and technic and results of fundoplication. Ann Surg. 1971;173:775–81.

    Article  PubMed  Google Scholar 

  7. Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic nissen fundoplication: preliminary report. Surg Laparosc Endosc. 1991;1:138–43.

    PubMed  CAS  Google Scholar 

  8. Finks JF, Wei Y, Birkmeyer JD. The rise and fall of antireflux surgery in the United States. Surg Endosc. 2006;20:1698–701.

    Article  PubMed  Google Scholar 

  9. Wang YR, Dempsey DT, Richter JE. Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993–2006. Dis Esophagus. 2011;24:215–23.

    Article  PubMed  CAS  Google Scholar 

  10. •• Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American gastroenterological association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383–91. The AGA implemented clinical practice guidelines which adresses current major management issues in GERD patients. In this medical statement the AGA institute focuses on 12 main questions regarding diagnostic and management strategies (e.g. role of diagnostic tests, extraesophageal reflux, lifestyle modification, medical and surgical treatment).

    Article  PubMed  Google Scholar 

  11. • Kahrilas PJ, Howden CW, Hughes N. Response of regurgitation to proton pump inhibitor therapy in clinical trials of gastroesophageal reflux disease. Am J Gastroenterol. 2011;106:1419–25. Kahrilas and collegues show in this systematic review the high prevalence of symptomatic regurgitation among patients with GERD and the modest therapeutic gain with PPI treatment compared to heartburn. Concluding that regurgitation is likely an important factor for determining incomplete PPI response.

    Article  PubMed  Google Scholar 

  12. Corley DA, Kubo A, Zhao W, Quesenberry C. Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology. 2010;139:93–101.

    Article  PubMed  Google Scholar 

  13. Burkard T, Kaiser CA, Brunner-La Rocca H, et al.: Combined clopidogrel and proton pump inhibitor therapy is associated with higher cardiovascular event rates after percutaneous coronary intervention: a report from the BASKET trial. J Intern Med 2011,

  14. Fohl AL, Regal RE. Proton pump inhibitor-associated pneumonia: not a breath of fresh air after all? World J Gastrointest Pharmacol Ther. 2011;2:17–26.

    Article  PubMed  Google Scholar 

  15. Howell MD, Novack V, Grgurich P, et al. Iatrogenic gastric acid suppression and the risk of nosocomial clostridium difficile infection. Arch Intern Med. 2010;170:784–90.

    Article  PubMed  Google Scholar 

  16. Cundy T, Mackay J. Proton pump inhibitors and severe hypomagnesaemia. Curr Opin Gastroenterol. 2011;27:180–5.

    Article  PubMed  CAS  Google Scholar 

  17. Singh R, Mei SC, Sethi S. Advanced endoscopic imaging in Barrett’s oesophagus: a review on current practice. World J Gastroenterol. 2011;17:4271–6.

    Article  PubMed  Google Scholar 

  18. Campos GM, Peters JH, DeMeester TR, et al. Multivariate analysis of factors predicting outcome after laparoscopic nissen fundoplication. J Gastrointest Surg. 1999;3:292–300.

    Article  PubMed  CAS  Google Scholar 

  19. Prakash C, Clouse RE. Value of extended recording time with wireless pH monitoring in evaluating gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2005;3:329–34.

    Article  PubMed  Google Scholar 

  20. Wiener GJ, Morgan TM, Copper JB, et al. Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters. Dig Dis Sci. 1988;33:1127–33.

    Article  PubMed  CAS  Google Scholar 

  21. Peters JH: Anatomic and Physiologic Testing of Esophageal Function. In: Mastery of Endoscopic and Laparoscopic Surgery (3rd Edition). Edited by Soper N and Swanstrom L. Lippincott Williams & Wilkins; 2008: 68–82

  22. Lundell L, Attwood S, Ell C, et al. Comparing laparoscopic antireflux surgery with esomeprazole in the management of patients with chronic gastro-oesophageal reflux disease: a 3-year interim analysis of the LOTUS trial. Gut. 2008;57:1207–13.

    Article  PubMed  CAS  Google Scholar 

  23. • Mardani J, Lundell L, Engstrom C. Total or posterior partial fundoplication in the treatment of GERD: results of a randomized trial after 2 decades of follow-up. Ann Surg. 2011;253:875–8. With a mean follow up time of 18 years, this publication compares the symptomatic outcome of open Nissen versus Toupet fundoplication in the long-term. Interestingly, mechanical side effects which initially favored the partial wrap, seem to resolve over this long period of time, while no differences in symptom controll were observed.

    Article  PubMed  Google Scholar 

  24. Sgromo B, Irvine LA, Cuschieri A, Shimi SM. Long-term comparative outcome between laparoscopic total nissen and toupet fundoplication: symptomatic relief, patient satisfaction and quality of life. Surg Endosc. 2008;22:1048–53.

    Article  PubMed  CAS  Google Scholar 

  25. Varin O, Velstra B, De Sutter S, Ceelen W. Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis. Arch Surg. 2009;144:273–8.

    Article  PubMed  Google Scholar 

  26. Tan G, Yang Z, Wang Z. Meta-analysis of laparoscopic total (nissen) versus posterior (toupet) fundoplication for gastro-oesophageal reflux disease based on randomized clinical trials. ANZ J Surg. 2011;81:246–52.

    Article  PubMed  Google Scholar 

  27. Evans SR, Jackson PG, Czerniach DR, et al. A stepwise approach to laparoscopic nissen fundoplication: avoiding technical pitfalls. Arch Surg. 2000;135:723–8.

    Article  PubMed  CAS  Google Scholar 

  28. • St Peter SD, Barnhart DC, Ostlie DJ, et al. Minimal vs extensive esophageal mobilization during laparoscopic fundoplication: a prospective randomized trial. J Pediatr Surg. 2011;46:163–8. St Peter and collegues adress the controversy regarding minimal versus extensive intraoperative mobilization of the esophagus and whether the approach alters the rate of wrap migration and need for re-operation. Although the study population was consistent of pediatric patients, their results shoulds raise the awareness of the extent of esophageal dissection and corresponding clinical outcome in an adult population as well.

    Article  PubMed  Google Scholar 

  29. Mucio M, Rojano M, Herrera JJ, et al. Novel surgical concept in antireflux surgery: long-term outcomes comparing 3 different laparoscopic approaches. Surgery. 2012;151:84–93.

    Article  PubMed  Google Scholar 

  30. Bochkarev V, Lee YK, Vitamvas M, Oleynikov D. Short esophagus: how much length can we get? Surg Endosc. 2008;22:2123–7.

    Article  PubMed  Google Scholar 

  31. Engstrom C, Jamieson GG, Devitt PG, Watson DI. Meta-analysis of two randomized controlled trials to identify long-term symptoms after division of the short gastric vessels during nissen fundoplication. Br J Surg. 2011;98:1063–7.

    Article  PubMed  CAS  Google Scholar 

  32. Markar SR, Karthikesalingam AP, Wagner OJ, et al. Systematic review and meta-analysis of laparoscopic nissen fundoplication with or without division of the short gastric vessels. Br J Surg. 2011;98:1056–62.

    Article  PubMed  CAS  Google Scholar 

  33. Watson DI, Jamieson GG, Devitt PG, et al. A prospective randomized trial of laparoscopic nissen fundoplication with anterior vs posterior hiatal repair. Arch Surg. 2001;136:745–51.

    Article  PubMed  CAS  Google Scholar 

  34. Koch OO, Asche KU, Berger J, et al. Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg Endosc. 2011;25:1024–30.

    Article  PubMed  Google Scholar 

  35. Oelschlager BK, Lal DR, Jensen E, et al. Medium- and long-term outcome of laparoscopic redo fundoplication. Surg Endosc. 2006;20:1817–23.

    Article  PubMed  CAS  Google Scholar 

  36. Mickevicius A, Endzinas Z, Kiudelis M, et al. Influence of wrap length on the effectiveness of nissen and toupet fundoplication: a prospective randomized study. Surg Endosc. 2008;22:2269–76.

    Article  PubMed  Google Scholar 

  37. Muller-Stich BP, Reiter MA, Wente MN, et al. Robot-assisted versus conventional laparoscopic fundoplication: short-term outcome of a pilot randomized controlled trial. Surg Endosc. 2007;21:1800–5.

    Article  PubMed  CAS  Google Scholar 

  38. Nakadi IE, Melot C, Closset J, et al. Evaluation of da vinci nissen fundoplication clinical results and cost minimization. World J Surg. 2006;30:1050–4.

    Article  PubMed  Google Scholar 

  39. Draaisma WA, Ruurda JP, Scheffer RC, et al. Randomized clinical trial of standard laparoscopic versus robot-assisted laparoscopic nissen fundoplication for gastro-oesophageal reflux disease. Br J Surg. 2006;93:1351–9.

    Article  PubMed  CAS  Google Scholar 

  40. Morino M, Pellegrino L, Giaccone C, et al. Randomized clinical trial of robot-assisted versus laparoscopic nissen fundoplication. Br J Surg. 2006;93:553–8.

    Article  PubMed  CAS  Google Scholar 

  41. Muller-Stich BP, Reiter MA, Mehrabi A, et al. No relevant difference in quality of life and functional outcome at 12 months’ follow-up-a randomised controlled trial comparing robot-assisted versus conventional laparoscopic nissen fundoplication. Langenbecks Arch Surg. 2009;394:441–6.

    Article  PubMed  CAS  Google Scholar 

  42. Broeders JA, Draaisma WA, Rijnhart-de Jong HG, et al. Impact of surgeon experience on 5-year outcome of laparoscopic nissen fundoplication. Arch Surg. 2011;146:340–6.

    Article  PubMed  Google Scholar 

  43. Mehta S, Bennett J, Mahon D, Rhodes M. Prospective trial of laparoscopic nissen fundoplication versus proton pump inhibitor therapy for gastroesophageal reflux disease: seven-year follow-up. J Gastrointest Surg. 2006;10:1312–7.

    Article  PubMed  Google Scholar 

  44. Mahon D, Rhodes M, Decadt B, et al. Randomized clinical trial of laparoscopic nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux. Br J Surg. 2005;92:695–9.

    Article  PubMed  CAS  Google Scholar 

  45. Hakanson BS, Thor KB, Thorell A, Ljungqvist O. Open vs laparoscopic partial posterior fundoplication. A prospective randomized trial. Surg Endosc. 2007;21:289–98.

    Article  PubMed  CAS  Google Scholar 

  46. Bais JE, Bartelsman JF, Bonjer HJ, et al. Laparoscopic or conventional nissen fundoplication for gastro-oesophageal reflux disease: randomised clinical trial. The Netherlands Antireflux Surgery Study Group. Lancet. 2000;355:170–4.

    Article  PubMed  CAS  Google Scholar 

  47. Anvari M, Allen C, Marshall J, et al. A randomized controlled trial of laparoscopic nissen fundoplication versus proton pump inhibitors for treatment of patients with chronic gastroesophageal reflux disease: one-year follow-up. Surg Innov. 2006;13:238–49.

    Article  PubMed  Google Scholar 

  48. Ciovica R, Gadenstatter M, Klingler A, et al. Quality of life in GERD patients: medical treatment versus antireflux surgery. J Gastrointest Surg. 2006;10:934–9.

    Article  PubMed  Google Scholar 

  49. Niebisch S, Fleming FJ, Galey KM, et al.: Perioperative risk of laparoscopic fundoplication: safer than previously reported—analysis of the ACS NSQIP 2005–2009. Presented at the 119th Western Surgical Association Annual Meeting. Tucson, Arizona, USA; November 13–16, 2011

  50. • Varban OA, McCoy TP, Westcott C. A comparison of pre-operative comorbidities and post-operative outcomes among patients undergoing laparoscopic nissen fundoplication at high- and low-volume centers. J Gastrointest Surg. 2011;15:1121–7. Whether laparoscopic antireflux surgery should be performed in experienced centers or not is controverse. The large cohort analysis by Varban et al. compare perioperative complications in low- and high-volume centers with regard to pre-existing co-morbidities and argue for a “regionalization” of laparoscopic fundoplication.

    Article  PubMed  Google Scholar 

  51. Dallemagne B, Weerts J, Markiewicz S, et al. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc. 2006;20:159–65.

    Article  PubMed  CAS  Google Scholar 

  52. Morgenthal CB, Lin E, Shane MD, et al. Who will fail laparoscopic nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc. 2007;21:1978–84.

    Article  PubMed  Google Scholar 

  53. Gee DW, Andreoli MT, Rattner DW. Measuring the effectiveness of laparoscopic antireflux surgery: long-term results. Arch Surg. 2008;143:482–7.

    Article  PubMed  Google Scholar 

  54. Zaninotto G, Portale G, Costantini M, et al. Long-term results (6–10 years) of laparoscopic fundoplication. J Gastrointest Surg. 2007;11:1138–45.

    Article  PubMed  Google Scholar 

  55. Kelly JJ, Watson DI, Chin KF, et al. Laparoscopic nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg. 2007;205:570–5.

    Article  PubMed  Google Scholar 

  56. •• Galmiche JP, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. Jama. 2011;305:1969–77. Together with the 3-year interim analysis of the LOTUS trial [22], this multicenter randomized clinical trial comparing maintance therapy with PPI versus laparoscopic fundoplication concludes after a 5 year follow up. Uniquie in this trial is the standardization of surgical technique in antireflux surgery among participating centers.

    Article  PubMed  CAS  Google Scholar 

  57. Anvari M, Allen C, Marshall J, et al. A randomized controlled trial of laparoscopic nissen fundoplication versus proton pump inhibitors for the treatment of patients with chronic gastroesophageal reflux disease (GERD): 3-year outcomes. Surg Endosc. 2011;25:2547–54.

    Article  PubMed  Google Scholar 

  58. Brown SR, Gyawali CP, Melman L, et al. Clinical outcomes of atypical extra-esophageal reflux symptoms following laparoscopic antireflux surgery. Surg Endosc. 2011;25:3852–8.

    Article  PubMed  Google Scholar 

  59. Dassinger MS, Torquati A, Houston HL, et al. Laparoscopic fundoplication: 5-year follow-up. Am Surg. 2004;70:691–5.

    PubMed  CAS  Google Scholar 

  60. Kamolz T, Granderath FA, Schweiger UM, Pointner R. Laparoscopic nissen fundoplication in patients with nonerosive reflux disease. Long-term quality-of-life assessment and surgical outcome. Surg Endosc. 2005;19:494–500.

    Article  PubMed  CAS  Google Scholar 

  61. Rosenthal R, Peterli R, Guenin MO, et al. Laparoscopic antireflux surgery: long-term outcomes and quality of life. J Laparoendosc Adv Surg Tech A. 2006;16:557–61.

    Article  PubMed  Google Scholar 

  62. Cowgill SM, Gillman R, Kraemer E, et al. Ten-year follow up after laparoscopic nissen fundoplication for gastroesophageal reflux disease. Am Surg. 2007;73:748–53.

    PubMed  Google Scholar 

  63. Anvari M, Allen C. Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic nissen fundoplication. J Am Coll Surg. 2003;196:51–9.

    Article  PubMed  Google Scholar 

  64. Brouwer R, Kiroff GK. Improvement of respiratory symptoms following laparoscopic nissen fundoplication. ANZ J Surg. 2003;73:189–93.

    Article  PubMed  Google Scholar 

  65. Francis DO, Goutte M, Slaughter JC, et al. Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux. Laryngoscope. 2011;121:1902–9.

    Article  PubMed  Google Scholar 

  66. Byrne JP, Smithers BM, Nathanson LK, et al. Symptomatic and functional outcome after laparoscopic reoperation for failed antireflux surgery. Br J Surg. 2005;92:996–1001.

    Article  PubMed  CAS  Google Scholar 

  67. Awais O, Luketich JD, Schuchert MJ, et al. Reoperative antireflux surgery for failed fundoplication: an analysis of outcomes in 275 patients. Ann Thorac Surg. 2011;92:1083–90.

    Article  PubMed  Google Scholar 

  68. Ohnmacht GA, Deschamps C, Cassivi SD, et al. Failed antireflux surgery: results after reoperation. Ann Thorac Surg. 2006;81:2050–4.

    Article  PubMed  Google Scholar 

  69. Iqbal A, Awad Z, Simkins J, et al. Repair of 104 failed anti-reflux operations. Ann Surg. 2006;244:42–51.

    Article  PubMed  Google Scholar 

  70. Coelho JC, Goncalves CG, Claus CM, et al. Late laparoscopic reoperation of failed antireflux procedures. Surg Laparosc Endosc Percutan Tech. 2004;14:113–7.

    Article  PubMed  Google Scholar 

  71. Cowgill SM, Arnaoutakis D, Villadolid D, Rosemurgy AS. “Redo” fundoplications: satisfactory symptomatic outcomes with higher cost of care. J Surg Res. 2007;143:183–8.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue; Box SURG, Rochester, NY, 14642, USA

    Stefan Niebisch & Jeffrey H. Peters

Authors
  1. Stefan Niebisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey H. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey H. Peters.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Niebisch, S., Peters, J.H. Update on Fundoplication for the Treatment of GERD. Curr Gastroenterol Rep 14, 189–196 (2012). https://doi.org/10.1007/s11894-012-0256-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-012-0256-6

Keywords

Search

Navigation