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Partial versus complete fundoplication for the correction of pediatric GERD: a systematic review and meta-analysis.

ABSTRACT: BACKGROUND:There is no consensus as to what extent of "wrap" is required in a fundoplication for correction of gastroesophageal reflux disease (GERD). OBJECTIVE:To evaluate if a complete (360 degree) or partial fundoplication gives better control of GERD. METHODS:A systematic search of MEDLINE and Scopus identified interventional and observational studies of fundoplication in children. Screening identified those comparing techniques. The primary outcome was recurrence of GERD following surgery. Dysphagia and complications were secondary outcomes of interest. Meta-analysis was performed when appropriate. Study quality was assessed using the Cochrane Risk of Bias Tool. RESULTS:2289 abstracts were screened, yielding 2 randomized controlled trials (RCTs) and 12 retrospective cohort studies. The RCTs were pooled. There was no difference in surgical success between partial and complete fundoplication, OR 1.33 [0.67,2.66]. In the 12 cohort studies, 3 (25%) used an objective assessment of the surgery, one of which showed improved outcomes with complete fundoplication. Twenty-five different complications were reported; common were dysphagia and gas-bloat syndrome. Overall study quality was poor. CONCLUSIONS:The comparison of partial fundoplication with complete fundoplication warrants further study. The evidence does not demonstrate superiority of one technique. The lack of high quality RCTs and the methodological heterogeneity of observational studies limits a powerful meta-analysis.

SUBMITTER: Glen P

PROVIDER: S-EPMC4227692 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Partial versus complete fundoplication for the correction of pediatric GERD: a systematic review and meta-analysis.

Glen Peter P Chassé Michaël M Doyle Mary-Anne MA Nasr Ahmed A Fergusson Dean A DA

PloS one 20141111 11

<h4>Background</h4>There is no consensus as to what extent of "wrap" is required in a fundoplication for correction of gastroesophageal reflux disease (GERD).<h4>Objective</h4>To evaluate if a complete (360 degree) or partial fundoplication gives better control of GERD.<h4>Methods</h4>A systematic search of MEDLINE and Scopus identified interventional and observational studies of fundoplication in children. Screening identified those comparing techniques. The primary outcome was recurrence of GE ...[more]

PMID: 25386679

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Project description:Introduction: Cryoablation has been considered as the most efficacious ablative alternative to partial nephrectomy (PN) for selected patients. Our objective is to assess the existing evidence relating to the safety and efficacy of cryoablation compared with PN for clinical T1 renal masses. Materials and Methods: A comprehensive search of PMC, EMBASE, and the Cochrane Library was conducted to identify studies containing comparison of cryoablation and PN. By utilizing those included studies, a systematic review and cumulative meta-analyses were performed to assess the safety and efficacy between cryoablation and PN for T1 renal masses. Results: 17 retrospective studies providing available data were included in our study. Significant differences were found about all oncological variables including all-cause death, cancer-specific death, metastasis and local-recurrence (p < 0.001, p = 0.03, p < 0.001, and p < 0.001, respectively) between the PN group and the cryoablation group. The mean difference between two groups for percent estimated glomerular filtration rate decrease and creatinine increase was -4.84 and 0.15 respectively (p < 0.001 and p = 0.006, respectively). The incidences of overall and postoperative complications in the PN group were significantly higher than that in the cryoablation group (p = 0.001 and p < 0.001, respectively), but the result about intraoperative complications didn't show a significant difference between the two groups (p = 0.53). Conclusions: Comparing with PN, cryoablation for clinical T1 renal tumors is associated with poorer oncological outcomes, but the existing disadvantages are accompanied by lower rate of overall and postoperative complications and superior renal functional preservation. For patients with imperative indications for nephron-sparing surgery who can't risk more invasive PN, cryoablation could be an attractive option. Owing to the inherent limitations of eligible studies, conclusions drawn from our meta-analyses should be interpreted cautiously and be confirmed further with well-designed randomized controlled trials with extensive follow-up length.

Dataset Information

Partial versus complete fundoplication for the correction of pediatric GERD: a systematic review and meta-analysis.

Publications

Partial versus complete fundoplication for the correction of pediatric GERD: a systematic review and meta-analysis.

Similar Datasets

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