Anterior Partial Fundoplication

  • David I. WatsonEmail author
  • Björn Törnqvist


For more than five decades, the gold standard operation for gastro-esophageal reflux disease has been Nissen fundoplication. However, in some patients wrapping the gastric fundus fully around the esophagus is followed by troublesome new symptoms such as abdominal bloating, dysphagia, inability to belch and flatulence, and these problems are probably generated by an over-competent valve which results following Nissen fundoplication. To reduce the risk of these side effects, surgeons have evaluated various modifications to the Nissen procedure, including partial fundoplications in which the gastric fundus is wrapped only part way around the distal esophagus, thereby generating a more physiological gastro-esophageal valve mechanism. A partial fundoplication can be constructed using either an anterior or a posterior approach, with the lowest risk of side effects following anterior partial fundoplication variants. Long-term follow-up from randomized controlled trials demonstrate that anterior partial fundoplications are followed by a reduced risk of side effects, and the overall success rate, defined using measures of overall satisfaction with the surgical outcome, is at least as good as following Nissen fundoplication. However, there are trade-offs between the risks of recurrent reflux vs. side effects, and these balance somewhat, with differences in these risks correlating with the extent of the fundoplication constructed. This chapter describes the indications, critical technical aspects pertinent to the creation of a satisfactory anterior partial fundoplication, and outcomes.


Fundoplication Partial fundoplication Gastro-esophageal reflux Surgery 


  1. 1.
    Kelly JJ, Watson DI, Chin KF, et al. Laparoscopic Nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg. 2007;205:570–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Catarci M, Gentileschi P, Papi C, et al. Evidence-based appraisal of antireflux fundoplication. Ann Surg. 2004;239:325–37.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Varin O, Velstra B, De Sutter S, Ceelen W. Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis. Arch Surg. 2009;144:273–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Broeders JA, Mauritz FA, Ahmed Ali U, et al. Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg. 2010;97:1318–30.CrossRefPubMedGoogle Scholar
  5. 5.
    Chen Z, Bessell JR, Chew A, Watson DI. Laparoscopic cardiomyotomy for achalasia: clinical outcomes beyond 5 years. J Gastrointest Surg. 2010;14:594–600.CrossRefPubMedGoogle Scholar
  6. 6.
    Watson DI, Jamieson GG, Bessell JR, Devitt PG. Laparoscopic fundoplication in patients with an aperistaltic esophagus and gastroesophageal reflux. Dis Esophagus. 2006;19:94–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Ratnasingam D, Irvine T, Thompson SK, Watson DI. Laparoscopic antireflux surgery in patients with throat symptoms: a word of caution. World J Surg. 2011;35:342–8.CrossRefPubMedGoogle Scholar
  8. 8.
    O'Boyle CJ, Watson DI, DeBeaux AC, Jamieson GG. Preoperative prediction of long-term outcome following laparoscopic fundoplication. ANZ J Surg. 2002;72:471–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Chen Z, Thompson SK, Jamieson GG, et al. Anterior 180-degree partial fundoplication: a 16-year experience with 548 patients. J Am Coll Surg. 2011;212:827–34.CrossRefPubMedGoogle Scholar
  10. 10.
    Engstrom C, Cai W, Irvine T, et al. Twenty years of experience with laparoscopic antireflux surgery. Br J Surg. 2012;99:1415–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Cai W, Watson DI, Lally CJ, et al. Ten-year clinical outcome of a prospective randomized clinical trial of laparoscopic Nissen versus anterior 180(degrees) partial fundoplication. Br J Surg. 2008;95:1501–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Krysztopik RJ, Jamieson GG, Devitt PG, Watson DI. A further modification of fundoplication. 90 degrees anterior fundoplication. Surg Endosc. 2002;16:1446–51.CrossRefPubMedGoogle Scholar
  13. 13.
    Gatenby PA, Bright T, Watson DI. Anterior 180 degrees partial fundoplication--how I do it. J Gastrointest Surg. 2012;16:2297–303.CrossRefPubMedGoogle Scholar
  14. 14.
    Watson A, Jenkinson LR, Ball CS, et al. A more physiological alternative to total fundoplication for the surgical correction of resistant gastro-oesophageal reflux. Br J Surg. 1991;78:1088–94.CrossRefPubMedGoogle Scholar
  15. 15.
    Watson DI, Jamieson GG, Pike GK, et al. Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg. 1999;86:123–30.CrossRefPubMedGoogle Scholar
  16. 16.
    Ludemann R, Watson DI, Jamieson GG, et al. Five-year follow-up of a randomized clinical trial of laparoscopic total versus anterior 180 degrees fundoplication. Br J Surg. 2005;92:240–3.CrossRefPubMedGoogle Scholar
  17. 17.
    Baigrie RJ, Cullis SN, Ndhluni AJ, Cariem A. Randomized double-blind trial of laparoscopic Nissen fundoplication versus anterior partial fundoplication. Br J Surg. 2005;92:819–23.CrossRefPubMedGoogle Scholar
  18. 18.
    Cao Z, Cai W, Qin M, et al. Randomized clinical trial of laparoscopic anterior 180 degrees partial versus 360 degrees Nissen fundoplication: 5-year results. Dis Esophagus. 2012;25:114–20.CrossRefPubMedGoogle Scholar
  19. 19.
    Raue W, Ordemann J, Jacobi CA, et al. Nissen versus Dor fundoplication for treatment of gastroesophageal reflux disease: a blinded randomized clinical trial. Dig Surg. 2011;28:80–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Broeders JA, Broeders EA, Watson DI, et al. Objective outcomes 14 years after laparoscopic anterior 180-degree partial versus nissen fundoplication: results from a randomized trial. Ann Surg. 2013;258:233–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Engstrom C, Lonroth H, Mardani J, Lundell L. An anterior or posterior approach to partial fundoplication? Long-term results of a randomized trial. World J Surg. 2007;31:1221–5; discussion: 1226–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Watson DI, Jamieson GG, Lally C, et al. Multicenter, prospective, double-blind, randomized trial of laparoscopic nissen vs anterior 90 degrees partial fundoplication. Arch Surg. 2004;139:1160–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Nijjar RS, Watson DI, Jamieson GG, et al. Five-year follow-up of a multicenter, double-blind randomized clinical trial of laparoscopic Nissen vs anterior 90 degrees partial fundoplication. Arch Surg. 2010;145:552–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Spence GM, Watson DI, Jamiesion GG, et al. Single center prospective randomized trial of laparoscopic Nissen versus anterior 90 degrees fundoplication. J Gastrointest Surg. 2006;10:698–705.CrossRefPubMedGoogle Scholar
  25. 25.
    Chisholm JA, Jamieson GG, Lally CJ, et al. The effect of obesity on the outcome of laparoscopic antireflux surgery. J Gastrointest Surg. 2009;13:1064–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Flinders University Department of SurgeryFlinders Medical CentreAdelaideAustralia
  2. 2.Department of Upper Gastrointestinal SurgeryKarolinska University HospitalStockholmSweden

Personalised recommendations