Laparoscopic vs. open Nissen's fundoplication for gastro-oesophageal reflux disease in children: A meta-analysis

• For children treated by LNF, the incidence rate of recurrence ranged from 5.56% to 36.36% and that in ONF group ranged from 4.76% to 9.52%.
• For children treated by LNF, the incidence rate of mortality ranged from 9.09% to 17.39% and that in ONF group ranged from 9.09% to 14.29%.
• There was not a statistical difference in mortality, postoperative complications, readmission, and hospital stay between LNF and ONF.
• LNF was associated with more incidence of recurrence, longer surgery duration, but fewer retching than ONF.

Background and objectiveAvailable evidence showed inconsistent results between laparoscopic Nissen's fundoplication (LNF) and open Nissen's fundoplication (ONF) for children with gastro-oesophageal reflux disease (GERD), so this study aimed to evaluate the efficacy and safety between LNF and ONF.MethodsSystematic, comprehensive literature searches were conducted to include randomized controlled trials (RCTs) that compared LNF and ONF for GERD. Two reviewers independently selected studies, abstracted data and assessed the methodological quality and evidence level. Data was analyzed by Review Manager Version 5.0. Risk ratio (RR) was used for dichotomous outcomes, and mean difference (MD) was used for continuous scales. Heterogeneity was estimated with the I2 statistic, fixed-effect model was used if I2 <50%, and otherwise random-effects model was used.ResultsThree RCTs (171 children) were included. There was not a statistical difference in mortality (RR 1.12, 95%CI 0.50 2.48), or postoperative complications (RR 0.87, 95%CI 0.61 1.25), readmission (RR 1.53, 95%CI 0.67 3.51), or hospital stay (MD 0.85, 95%CI -0.06 1.75) between LNF and ONF. But LNF was associated with more incidence of recurrence (RR 3.32, 95%CI 1.40 7.84), longer surgery duration (MD 76.33, 95%CI 69.37 83.28), but fewer retching (RR 0.11, 95%CI 0.02 0.58) than ONF.ConclusionsLNF might be as effective and safe as ONF in the short and long term, but both were associated with high risk of recurrence and mortality, especially for those children with neurological impairment, before the age of 18 months and female gender. This required a comprehensive evaluation of children before surgery.