Fundoplication vs. Optimal Medical Management for Chronic GERD

In the long run, patients with gastroesophageal reflux disease experienced greater improvements with surgery.

Laparoscopic fundoplication relieves symptoms of gastroesophageal reflux disease (GERD). However, whether fundoplication provides long-term relief is unclear. In this study, investigators in the U.K. randomized 360 patients with GERD who had been treated for >12 months with proton-pump inhibitors (PPIs) to either laparoscopic fundoplication or optimal medical management; follow-up was 5 years. Patients who declined to participate because of strong preferences for either surgery or medical management were followed in two nonrandomized arms of the trial. One-year outcomes were reported previously (JW Gen Med Jan 27 2009).

At 5 years, 63% of patients randomized to surgery and 13% of those randomized to medical management had undergone fundoplication; 44% and 82%, respectively, were using anti-reflux drugs (PPIs). Scores on a validated measure of health-related quality of life significantly favored surgery. Results were similar for nonrandomized patients. Of all patients who underwent fundoplication, 4% had reflux-related reoperations (mostly reconstruction of, or conversion to, another wrap), and about 3% suffered late postoperative complications (e.g., incisional hernia).

CITATION(S):

Grant AM et al. Minimal access surgery compared with medical management for gastro-oesophageal reflux disease: Five year follow-up of a randomised controlled trial (REFLUX). BMJ 2013 Apr 18; 346:f1908.