Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12882-12887
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12882
Comparison of Stretta procedure and toupet fundoplication for gastroesophageal reflux disease-related extra-esophageal symptoms
Chao Yan, Wei-Tao Liang, Zhong-Gao Wang, Zhi-Wei Hu, Ji-Min Wu, Chao Zhang, Mei-Ping Chen
Chao Yan, Wei-Tao Liang, Zhong-Gao Wang, Zhi-Wei Hu, Ji-Min Wu, Mei-Ping Chen, Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, Beijing 100088, China
Chao Yan, Wei-Tao Liang, Zhong-Gao Wang, Chao Zhang, Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Yan C, Liang WT, Wang ZG, Hu ZW, Wu JM, Zhang C and Chen MP designed and performed the research; Yan C and Liang WT contributed the analytical tools; Yan C analyzed the data and wrote the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review boards of the Department of Vascular Surgery, Xuan Wu Hospital, and the Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army (Beijing, China).
Informed consent statement: All study participants or their legal guardians provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There are no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zhong-Gao Wang, MD, Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing 100053, China. zhonggaowang@hotmail.com
Telephone: +86-10-62015718
Received: May 18, 2015
Peer-review started: May 22, 2015
First decision: July 10, 2015
Revised: August 9, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: December 7, 2015
Abstract

AIM: To compare the outcomes between the Stretta procedure and laparoscopic toupet fundoplication (LTF) in patients with gastroesophageal reflux disease (GERD)-related extra-esophageal symptoms.

METHODS: From January 2011 to February 2012, a total of 98 patients diagnosed with GERD-related extra-esophageal symptoms who met the inclusion criteria were enrolled in this study. All patients who either underwent the Stretta procedure or LTF treatment have now completed the 3-year follow-up. Primary outcome measures, including frequency and severity of extra-esophageal symptoms, proton pump inhibitor (PPI) use, satisfaction, and postoperative complications, were assessed. The results of the Stretta procedure and LTF therapy were analyzed and compared.

RESULTS: There were 47 patients in the Stretta group and 51 patients in the LTF group. Ninety patients were available at the 3-year follow-up. The total of the frequency and severity scores for every symptom improved in both groups (P < 0.05). Improvement in symptom scores of cough, sputum, and wheezing did not achieve statistical significance between the two groups (P > 0.05). However, the score for globus hysterics was different between the Stretta group and the LTF group (4.9 ± 2.24 vs 3.2 ± 2.63, P < 0.05). After the Stretta procedure and LTF treatment, 29 and 33 patients in each group achieved PPI therapy independence (61.7% vs 64.7%, P = 0.835). The patients in the LTF group were more satisfied with their quality of life than those in the Stretta procedure group (P < 0.05). Most complications resolved without intervention within two weeks; however, two patients in the LTF group still suffered from severe dysphagia 2 wk after the operation, and it improved after bougie dilation treatment in both patients.

CONCLUSION: The Stretta procedure and LTF were both safe and effective for the control of GERD-related extra-esophageal symptoms and the reduction of PPI use.

Keywords: Gastroesophageal reflux disease, Extra-esophageal symptoms, Laparoscopic Toupet fundoplication, Stretta procedure, Proton pump inhibitor use

Core tip: Laparoscopic toupet fundoplication offers equivalent symptom relief and a significantly lower risk of postoperative dysphagia compared with laparoscopic Nissen fundoplication. The Stretta procedure and laparoscopic Toupet fundoplication have been demonstrated to be effective and safe in controlling gastroesophageal reflux disease-related symptoms as minimally invasive procedures. Few studies have been conducted to compare the outcome between laparoscopic Toupet fundoplication and the Stretta procedure. In this prospective study, we compared the outcomes of patients who underwent the Stretta procedure and laparoscopic Toupet fundoplication and evaluated the efficacy of the techniques in controlling gastroesophageal reflux disease-related extra-esophageal symptoms.