For a study, the researchers sought to conduct a randomized controlled trial of Nissen versus anterior 180-degree partial fundoplication to determine extremely late clinical outcomes at up to 20 years of follow-up. Therefore, 107 people were randomly assigned to get Nissen or anterior 180-degree partial fundoplication. For 79 people, follow-up data from 15 to 20 years was available (41 Nissen, 38 anterior). A standardized questionnaire with 0 to 10 analog scores and yes/no items was used to determine reflux symptoms, side effects, and satisfaction with surgery. Heartburn (mean score 3.2 vs 1.4, P=.001) and proton pump inhibitor use (41.7% vs 17.1%, P=.023) were higher after anterior fundoplication, but this was offset by less dysphagia for solids (mean score 1.8 vs 3.3, P=.015) and a better ability to belch (84.2% vs 65.9%, P=.030). Both groups had identical outcome measures (mean satisfaction score 8.4 vs 8.0, P=.444; 86.8% vs 90.2% satisfied with the outcome). In addition, 6 people had revisions after anterior fundoplication (Nissen conversion for reflux – 6), and 7 people had modifications after Nissen fundoplication (Nissen to partial fundoplication for dysphagia – 5; redo Nissen for reflux – 1; paraesophageal hernia –1). Nissen and anterior 180-degree partial fundoplication demonstrated similar success after 15 to 20 years of follow-up, but with trade-offs between improved reflux management and higher side-effects following Nissen fundoplication.
