Fundoplication significantly improves objective and subjective reflux outcomes—a meta-analysis
Bibliographic record
Abstract
INTRODUCTION: Gastroesophageal reflux disease (GERD) impacts 10-30% of the population in the Western world. Surgical interventions including Laparoscopic Fundoplication (LF), Transoral Incisionless Fundoplication (TIF), and Magnetic Sphincter Augmentation (MSA) have proven effective in managing GERD. This meta-analysis aims to compare short- and long-term outcomes of these surgical options. METHODS: A comprehensive search of PubMed, Embase, Scopus, Cochrane, and Medline from 1980 to 2024 was conducted to identify randomized control trials or cohort designs that included adults with GERD who underwent fundoplication (Nissen, Toupet), MSA, or TIF and had preoperative and post-operative acid exposure time (AET), DeMeester score, and/or relief score (e.g., GERD-HRQL); we considered all post-operative outcome measurements. We excluded studies with any surgical variations of the procedures, reoperations, and studies not published in English. Risk of bias was assessed using the Oxford scoring system for randomized control trials and the Newcastle-Ottawa scale (NOS) for cohort designs. A total of 3912 studies were identified initially, with our review including 78 unique studies providing 166 post-operative outcome measurements. Given studies could include multiple post-operative outcome measurements, we used multilevel random-effects meta-analysis. Between-procedure comparisons were made using multilevel meta-regression. For all outcomes, more positive values indicated greater improvement; mean differences (MD) were estimated for AET and DeMeester scores, whereas standardized mean differences (SMD) were estimated for relief scores. RESULTS: A total of 9516 patients were included with an average age of 50.8 years (SD: 6.7) with 53.7% male and an average BMI of 27.1 (SD: 2.3). The median length of follow-up across all observations was 12 months (IQR: 6-24 months; range: 0.25-120.5 months). All procedures indicated a statistically significant mean improvement in AET, relief score, and DeMeester scores (Table 1). Compared to Nissen, TIF averaged significantly less mean improvement in AET (MD: - 4.06, 95% CI: - 8.03 to - 0.09, p = .045) and DeMeester score (MD: - 20.60, 95% CI: - 38.33 to - 2.88, p = .023), whereas MSA and Toupet averaged significantly better relief scores (SMD: 0.28, 95% CI: 0.01 to 0.56, p = .044 and SMD = 0.17, 95% CI: 0.01 to 0.32, p = .034, respectively). This review advances understanding of the objective and subjective improvement of the traditional and recent surgical anti-reflux procedures used for symptomatic GERD. Overall, Nissen fundoplication demonstrated significantly better improvement with acid exposure and DeMeester score compared to MSA and TIF. However, symptom relief scores are significantly improved with Toupet fundoplication and MSA compared to other surgical treatment options.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.016 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.041 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".