Long-term (>10 Years) Outcomes of Laparoscopic Nissen Fundoplication: A Systematic Review and Meta-Analysis.

Abstract

The aim of this meta-analysis was to evaluate long-term outcomes and patient-reported satisfaction after Laparoscopic Nissen fundoplication (LNF). LNF has demonstrated short-term and mid-term symptom relief in patients with gastroesophageal reflux disease (GERD). However, long-term outcomes have not been clearly defined. A systematic PubMed search identified studies of LNF for GERD with ≥10-year follow-up. The main outcome was effectiveness of the operation, which was determined by symptomatic improvement, esophagitis improvement, and proton pump inhibitor use. Secondary endpoints included adverse events, patient satisfaction, and willingness to undergo LNF again. A meta-analysis of proportions was performed to calculate weighted pooled estimates with 95% CIs, and paired t tests compared preoperative and postoperative symptoms. A total of 12 studies comprising 1334 patients were analyzed. The mean follow-up across studies was 13.1 (10 to 22) years. The presence of heartburn decreased from 94.2% to 33.7% ( P < 0.001), regurgitation from 68.7% to 13.4% ( P = 0.02), and esophagitis from 61.7% to 7.4% ( P = 0.001). The weighted pooled proportion of symptom recurrence was 17% (95% CI, 5%-47%). Postoperative proton pump inhibitor use was reported in 24% (95% CI, 14%-38%) of patients. Gas-bloating and dysphagia occurred in 53% (95% CI, 20%-83%) and 26% (95% CI, 18%-37%) of patients. Overall patient satisfaction was 87% (95% CI, 81%-92%), and 87% of patients (95% CI, 82%-90%) reported willingness to undergo LNF again. The proportion of patients requiring reoperation was 6% (95% CI, 3%-9%). LNF provides durable long-term improvement of GERD symptoms. Although postoperative gas-bloating and dysphagia are frequent, long-term patients' satisfaction is high.