BACKGROUND Despite the extensive literature on laparoscopic antireflux surgery, comparative evidence across different procedures is scarce. The aim of this study was to assess and rank the most efficacious and safe laparoscopic procedures for the management of gastroesophageal reflux disease. METHODS Medline, Embase, AMED, CINAHL, CENTRAL, and OpenGrey databases were queried for randomized trials comparing two or more laparoscopic antireflux procedures with each other or with medical treatment for the management of gastroesophageal reflux disease. Pairwise meta-analyses were conducted for each pair of interventions using a random-effects model. Network meta-analysis was employed to assess the relative efficacy and safety of laparoscopic antireflux procedures for the management of gastroesophageal reflux disease. RESULTS Forty-four publications reporting 29 randomized trials which included 1892 patients were identified. The network of treatments was sparse with only a closed loop between different types of wraps; 270°, 360°, anterior 180° and anterior 90°; and star network between 360° and other treatments; and between anterior 180° and other treatments. Laparoscopic 270° (odds ratio, OR 1.19, 95% confidence interval, CI 0.64-2.22), anterior 180°, and anterior 90° were equally effective as 360° for control of heartburn, although this finding was supported by low quality of evidence according to GRADE modification for NMA. The odds for dysphagia were lower after 270° (OR 0.38, 95%, CI 0.24-0.60), anterior 90° (moderate quality evidence), and anterior 180° (low-quality evidence) compared to 360°. The odds for gas-bloat were lower after 270° (OR 0.51, 95% CI 0.27, 0.95) and after anterior 90° compared to 360° (low-quality evidence). Regurgitation, morbidity, and reoperation were similar across treatments, albeit these were associated with very low-quality evidence. CONCLUSION Laparoscopic 270° fundoplication achieves a better outcome than 360° total fundoplication, especially in terms of postoperative dysphagia, although other types of partial fundoplication might be equally effective. REGISTRATION NO CRD42017074783.

中文翻译：

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评估腹腔镜抗反流手术治疗胃食管反流病的有效性和安全性：网络荟萃分析的系统评价。


背景尽管关于腹腔镜抗反流手术的文献很多，但不同手术的比较证据却很少。本研究的目的是评估和排名治疗胃食管反流病最有效和最安全的腹腔镜手术。方法 查询 Medline、Embase、AMED、CINAHL、CENTRAL 和 OpenGrey 数据库中的随机试验，比较两种或多种腹腔镜抗反流手术或与药物治疗治疗胃食管反流病的效果。使用随机效应模型对每对干预措施进行配对荟萃分析。采用网络荟萃分析来评估腹腔镜抗反流手术治疗胃食管反流病的相对疗效和安全性。结果 44 篇出版物报告了 29 项随机试验，其中包括 1892 名患者。治疗网络很稀疏，不同类型的包裹之间只有一个闭环； 270°、360°、前180°、前90°；以及360°之间的星网和其他处理；以及前 180° 和其他治疗之间。腹腔镜 270°（比值比，OR 1.19，95% 置信区间，CI 0.64-2.22）、前 180° 和前 90° 在控制胃灼热方面与 360° 同等有效，尽管这一发现得到低质量证据的支持根据 NMA 的 GRADE 修改。与 360° 相比，270° 后（OR 0.38，95%，CI 0.24-0.60）、前 90°（中等质量证据）和前 180°（低质量证据）发生吞咽困难的几率较低。与 360° 相比，270° 后（OR 0.51，95% CI 0.27，0.95）和前 90° 后发生胀气的几率较低（低质量证据）。 不同治疗方法的反流、发病率和再次手术相似，尽管这些证据的质量非常低。结论 腹腔镜 270° 胃底折叠术比 360° 全胃底折叠术取得了更好的结果，特别是在术后吞咽困难方面，尽管其他类型的部分胃底折叠术可能同样有效。注册号 CRD42017074783。