***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: HYPOTHESIS Laparoscopic anterior 90 degrees partial fundoplication for gastroesophageal reflux is associated with a lower incidence of postoperative dysphagia and other adverse effects compared with laparoscopic Nissen fundoplication . DESIGN A multicenter , prospect i ve , double-blind , r and omized controlled trial . SETTING Nine university teaching hospitals in 6 major cities in Australia and New Zeal and . PARTICIPANTS One hundred twelve patients with proven gastroesophageal reflux disease presenting for laparoscopic fundoplication were r and omized to undergo either a Nissen ( 52 patients ) or an anterior 90 degrees partial procedure ( 60 patients ) . Patients with esophageal motility disorders , patients requiring a concurrent abdominal procedure , and patients who had undergone previous antireflux surgery were excluded from this study . INTERVENTIONS Laparoscopic Nissen fundoplication with division of the short gastric vessels or laparoscopic anterior 90 degrees partial fundoplication . MAIN OUTCOME MEASURES Independent assessment of dysphagia , heartburn , and overall satisfaction 1 , 3 , and 6 months after surgery using multiple clinical grading systems . Objective measurement of esophageal manometric parameters , esophageal acid exposure , and endoscopic assessment . RESULTS Postoperative dysphagia , and wind-related adverse effects were less common after a laparoscopic anterior 90 degrees partial fundoplication . Relief of heartburn was better following laparoscopic Nissen fundoplication . Overall satisfaction was better after anterior 90 degrees partial fundoplication . Lower esophageal sphincter pressure , acid exposure , and endoscopy findings were similar for both procedures . CONCLUSIONS At the 6-month follow-up , laparoscopic anterior 90 degrees culine partial fundoplication is followed by fewer adverse effects than laparoscopic Nissen fundoplication with full fundal mobilization , and it achieves a higher rate of satisfaction with the overall outcome . However , this is offset to some extent by a greater likelihood of recurrent gastroesophageal reflux symptoms BACKGROUND Total fundoplication for gastro-oesophageal reflux disease may be followed by unwanted side-effects . A r and omized trial demonstrated that an anterior 180 degrees partial fundoplication achieved effective reflux control and was associated with fewer side-effects in the short term than total fundoplication . This paper reports longer-term ( 5 year ) outcomes from that trial . METHODS Between December 1995 and June 1997 , 107 patients were r and omized to undergo either laparoscopic total fundoplication or a laparoscopic anterior 180 degrees fundoplication .  After 5 years , 101 of 103 eligible patients ( 51 total , 50 anterior ) were available for follow-up . Each patient was interviewed by a single blinded investigator and a st and ardized question naire was completed . The question naire focused on symptoms and overall satisfaction with the results of fundoplication . RESULTS There were no significant differences between the two groups with regard to control of heartburn or patient satisfaction with the overall outcome . Dysphagia , measured by a visual analogue score for solid food and a composite dysphagia score , was worse at 5 years after total fundoplication . Symptoms of bloating , inability to belch and flatulence were also more common after total fundoplication . Reoperation was required for dysphagia in three patients after total fundoplication and for recurrent reflux in three patients after anterior fundoplication . CONCLUSION Anterior 180 degrees partial fundoplication was as effective as total fundoplication for managing the symptoms of gastro-oesophageal reflux in the longer term . It was associated with a lower incidence of side-effects , although this was offset by a slightly higher risk of recurrent reflux symptoms In Barrett ’s esophagus , total abolition of reflux may give maximum protection against the development of malignancy . To determine whether laparoscopic anterior fundoplication gives the same degree of antireflux control as a total fundoplication , we analyzed a prospect ively followed cohort of patients from r and omized controlled trials of laparoscopic antireflux surgery .  There were 167 patients who returned for routine esophageal pH studies within 6 months of surgery ( 123 laparoscopic total fundoplications and 44 anterior fundoplications ) . There was no difference in percentage time pH < 4 between fundoplication groups , but the total number of reflux episodes was significantly different ( total fundoplication , four reflux events vs. partial fundoplication , six reflux events ; p = 0.03 ) . It is difficult to believe that this difference is either biologically or clinical ly important . In patients with a second esophageal pH study more than 5 years later , both the percentage time pH < 4 ( 0.1 % total fundoplication vs. 2.7 % partial fundoplication ; p = 0.004 ) and total number of reflux episodes ( three total fundoplication vs. 24 partial fundoplication ; p = 0.002 ) were significantly different . However , the postoperative esophageal acid exposure was within the normal range for both total and partial fundoplication , so whether the statistical difference is clinical ly important , remains a moot point Objective : To compare 10 years outcome of a multicenter r and omized controlled trial on  laparoscopic ( LNF ) and conventional Nissen fundoplication ( CNF )  , with focus on effectiveness and reoperation rate . Summary of Background Data : LNF has replaced CNF as surgical treatment for  gastroesophageal reflux disease ( GERD ) . Decisions are based on equal short-term effectiveness and reduced morbidity , but confirmation by long-term level 1 evidence is lacking . Methods : From 1997 to 1999 , 177 proton pump inhibitor (PPI)-refractory GERD patients were r and omized to undergo LNF or  CNF . The 10 years results of surgery on reflux symptoms , general health , PPI use , and reoperation rates , are described . High-resolution manometry , 24-hour pH-impedance monitoring and barium swallow were performed in symptomatic patients only . Results : A total of 148 patients ( 79 LNF , 69 CNF ) participated in this 10-year follow-up study . GERD symptoms were relieved in 92.4 % and 90.7 % ( NS ) after LNF and CNF , respectively . Severity of heartburn and dysphagia were similar , but slightly more patients had relief of regurgitation after LNF ( 98.7 % vs. 91.0 % ; P = 0.030 ) . The percentage of patients using PPIs slowly increased with time in both groups to 26.6 % for LNF and 22.4 % for CNF ( NS ) . General health ( 74.7 % vs. 72.7 % ; NS ) and quality of life ( visual analogue scale score : 65.3 vs. 61.4 ; NS ) improved similarly in both groups . The percentage of patients who would have opted for surgery again was similar as well ( 78.5 % vs. 72.7 % ; NS ) . Twice as many patients underwent reoperation after CNF compared with LNF ( 12 [ 15.2 % ] vs. 24 [ 34.8 % ] ; P = 0.006 ) , including a higher number of incisional hernia corrections ( 2 vs. 9 ; P = 0.015 ) . Mean interval between operation and reintervention was longer after CNF ( 22.9 vs. 50.6 months ; P = 0.047 ) . Of the patients who were dependent on daily PPI therapy at 10 years ( LNF 10 , CNF 10 ) , 7 patients ( LNF 3 , CNF 4 ) had recurrent GERD on pH-impedance monitoring , 5 of them with some form of anatomic recurrence . A total of 13 of 20 ( 65.0 % ) patients did not have recurrent GERD . Fourteen patients had an abnormal high-resolution manometry . Conclusions : CNF carries a higher risk for surgical reintervention compared with LNF , mainly due to incisional hernia corrections . The 10-year effectiveness of LNF and CNF is comparable in terms of improvement of GERD symptoms , PPI use , quality of life , and objective reflux control . Consequently , the long-term results from this trial lend level 1 support to the use of LNF as the surgical procedure of choice for GERD BACKGROUND The effect of total ( Nissen ) and anterior partial fundoplication ( APF ) for the surgical treatment of gastroesophageal reflux disease ( GERD ) on the motor behavior of the esophagogastric axis has not been fully assessed . The purpose of this study was to assess any alterations in lower esophageal sphincter ( LES ) and gastric fundus motor parameters in GERD patients after Nissen or APF fundoplication .  METHODS Twenty four patients with documented GERD underwent either laparoscopic Nissen fundoplication ( n = 12 ) or laparoscopic APF ( n = 12 ) . Preoperative and postoperative stationary esophageal manometry included assessment of LES resting and postdeglutition relaxation pressures , intragastric pressure , and LES transient relaxations in the left lateral and upright positions and after gastric distension . RESULTS Both types of fundoplication result ed in significant increases in LES resting ( P < 0.001 ) and postdeglutition relaxation pressure ( P < 0.001 ) in both positions and after gastric distention . Intragastric pressure increased only after Nissen fundoplication in the postgastric distention state ( P = 0.01 ) . Transient LES relaxations were equally abolished after both procedures . All postoperative changes were to a similar level after either procedure with the exception of intragastric pressure after gastric distention , which was significantly higher after total than after partial fundoplication ( P = 0.04 ) . CONCLUSIONS Both procedures equally increase LES resting and postdeglutition relaxation pressures and abolish transient LES relaxations at all states . The significantly higher intragastric pressure at the postgastric distention state after Nissen fundoplication could possibly explain the higher incidence of epigastric fullness and discomfort after this type of antireflux surgery In the operative management of gastro‐oesophageal reflux , a balance must be achieved between adequate control of reflux and excessive dysphagia . The ideal technique is not known . A r and omized study was performed to determine whether laparoscopic anterior fundoplication is associated with a lower incidence of postoperative dysphagia than laparoscopic Nissen fundoplication , while achieving equivalent control of reflux How best to surgically treat GERD is an unresolved issue . To increase our insights into the fundoplication procedures , functional consequences for the gastroesophageal junction of an anterior or a posterior partial fundoplication were studied by manometry . Patients were r and omly selected from a larger study in a r and omised comparison between posterior and anterior partial fundoplications .  The manometric studies were done 12 months after respective procedures in 24 patients . The motor characteristics of the esophagus and lower esophageal sphincter ( LES ) function were determined by use of sleeve catheter manometry . The manometric characteristics of the esophageal body were similar in the study groups except for the ramp pressure . This was significantly higher in patients with posterior partial fundoplications . The posterior group had significantly longer total length ( P < 0.02 ) as well as longer intra-abdominal portions ( P = 0.07 ) of the LES while the basal tone , albeit numerically higher , did not reach statistical significance . Water-swallow induced LES relaxations reached lower nadir values in the anterior group ( 1.7 vs 2.7 mmHg ) . Gas distension triggered few transient LES relaxations in both study groups while common cavities were more frequently observed in those having an anterior partial wrap ( P < 0.01 ) . A posterior partial fundoplication is followed by manometric characteristics suggesting a well functioning antireflux barrier with some obstruction to bolus passage as well as restricted venting of air from the stomach . The manometric mechanisms behind the inferior reflux control achieved by a Watson type of anterior partial wrap has now been further eluci date BACKGROUND AND AIMS The purpose of this study was to determine whether esophageal dysmotility affects symptoms of gastroesophageal reflux disease or clinical outcome after  laparoscopic fundoplication  and whether esophagus motor function changes postoperatively . METHODS Two hundred patients with a history of long-st and ing gastroesophageal reflux disease were investigated by clinical assessment , upper gastrointestinal endoscopy , esophageal manometry , and 24-hour pH monitoring  between May 1999 and May 2000 . Patients were stratified according to presence or absence of esophageal dysmotility ( each n = 100 ) and r and omized to either 360 degrees ( Nissen ) or 270 degrees ( Toupet ) fundoplication .  At a 4-month postoperative follow-up , preoperative tests were repeated . RESULTS Preoperative esophageal dysmotility was associated with more severe reflux symptoms , more frequent resistance to medical treatment ( 64 % vs. 49 % ; P < 0.05 ) , and greater decrease in lower esophageal sphincter pressure ( 9.5 + /- 5.3 vs. 12.4 + /- 6.7 mm Hg ; P < 0.0005 ) compared with normal motility . Postoperatively , clinical outcome and reflux recurrence ( 21 % vs. 14 % ) were similar . Esophageal 
    Output:
    
Esophageal acid exposure time and the prevalence of heartburn are higher after LAF compared with LPF .
In the short-term this is counterbalanced by less severe dysphagia .
However , dysphagia scores become similar in the long-term , with a persistent substantial increase in prevalence of heartburn and PPI use after LAF .
The reoperation rate is twice as high after LAF as well , mainly due to re interventions for recurrent GERD .