A Prospective Randomized Trial of Laparoscopic Nissen Fundoplication With Anterior vs Posterior Hiatal Repair

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Abstract
SINCE THE EARLY 1990s, the status of laparoscopic antireflux surgery has moved from experimental to routine, with large experiences now reported by many centers.1-3 Furthermore, the outcome in the majority of patients undergoing such surgery is good, with relief of reflux symptoms and few adverse effects in about 90% of patients.1,4-6 However, some patients develop problems following fundoplication.6 Problems due to hiatal herniation after surgery are now less common because hiatal repair has become routine during laparoscopic Nissen fundoplication in most centers,7,8 but some patients still experience troublesome dysphagia following fundoplication. Recently reported randomized trials have suggested that the problem of dysphagia might be reduced following anterior partial fundoplication,6 while routine division of the short gastric vessels has not been demonstrated to be of benefit.9,10