***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: Objective To determine the influence of preoperative esophageal motility on clinical and objective outcome of the Toupet or Nissen fundoplication and to evaluate the success rate of these procedures . Summary background data Nissen fundoplication ( 360 ° ) is the st and ard operation in the surgical management of gastroesophageal reflux disease ( GERD ) . In order to avoid postoperative dysphagia it has been proposed to tailor antireflux surgery according to pre-existing esophageal motility . Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and it has been recommended to use the Toupet procedure ( 270 ° ) in these patients . We performed a r and omized trial to evaluate this tailored concept and to compare the two operative techniques concerning reflux control and complication rate ( dysphagia ) . Methods 200 patients with GERD were included in a prospect i ve , r and omized study . After preoperative examinations ( clinical interview , endoscopy , 24-hour pH-metry and esophageal manometry ) 100 patients underwent either a laparoscopic Nissen procedure  ( 50 with and 50 without motility disorders ) , or Toupet ( 50 with and 50 without motility disorders ) . Postoperative follow-up after two years included clinical interview , endoscopy , 24-hour pH-metry , and esophageal manometry . Results After two years 85 % ( Nissen ) and 85 % ( Toupet ) of patients were satisfied with the operative result . Dysphagia was more frequent following a Nissen fundoplication compared to Toupet ( 19 vs. 8 , p < 0.05 ) and did not correlate with preoperative motility . Concerning reflux control the Toupet proved to be as good as the Nissen procedure . Conclusion Tailoring antireflux surgery according to the esophageal motility is not indicated , as motility disorders are not correlated with postoperative dysphagia . The Toupet procedure is the better operation as it has a lower rate of dysphagia and is as good as the Nissen fundoplication in controlling reflux Background : Laparoscopic fundoplication is increasingly performed in pediatric surgery . Many types of fundoplication are performed , each has advantages and disadvantages . To date there has been no prospect i ve r and omized study to determine the optimal laparoscopic technique in children . The aim of the study was to compare the long-term outcomes and control of symptoms after  laparoscopic Nissen fundoplication with laparoscopic Thal fundoplication in children . Methods : Between July 1998 and April 2007 , 175 patients were recruited to this prospect i ve , r and omized study . Patients were assessed before the operation and after defined intervals starting at 3 months after surgery . The “ absolute ” outcome measure for fundoplication failure was recurrence of symptoms that merited a redofundoplication or insertion of a transgastric jejunostomy . “ Relative ” outcome measures were recurrence of symptoms necessitating re introduction of antireflux medication ( ie , “ intention to treat ” ) and postoperative complications ( eg , postoperative dysphagia ) . The median follow-up time was 30 months ( range , 1–109 ) . This study has been registered with clinical trials.gov ( NCT01027975 ) . Results : Long-term results were available in 167 patients of which 85 underwent a Nissen and 82 a Thal fundoplication .  Four patients in the Nissen group ( 4.7 % ) and 12 in the Thal group ( 14.6 % ) required a redofundoplication . One child in each group developed recurrence of symptoms and had a transgastric jejunostomy performed . The “ absolute ” failure rate was significant lower in the Nissen group ( n = 5 ; 5.9 % ) compared with the Thal group ( n = 13 ; 15.9 % ) ( P = 0.038 ) . The vast majority of these patients ( 17 of 18 ) had underlying neurological disorders . The “ relative ” failure rate ( ie , “ intention to treat ” ) was similar in both groups . Nearly one-quarter of patients developed postoperative dysphagia similarly distributed between both groups . However , severe dysphagia requiring endoscopy + /− dilatation was significantly higher in the Nissen group ( n = 10 , 11.8 % ) compared with the Thal group ( n = 2 ; 2.4 % ) ( P = 0.020 ) . One of 31 deaths ( 0.6 % ) in this series occurred after surgery , but was not directly related to the fundoplication technique . Conclusions : In the long-term a laparoscopic Nissen fundoplication had a significantly lower recurrence rate than a Thal fundoplication , particularly in patients with underlying neurological disorders . There was no significant difference between the 2 types of fundoplication in normal children . There was no significant difference between the need for restarting antireflux medication between both groups because of recurrence of moderate symptoms . The incidence of postoperative dysphagia was similar in the 2 groups , however , significantly more patients in the Nissen group required intervention for severe dysphagia . Overall the perioperative death rate was low even in high-risk patients BACKGROUND For the surgical treatment of gastrooesophageal reflux disease ( GORD ) , laparoscopic Nissen fundoplication has largely replaced the open procedure . Retrospective and prospect i ve non-r and omised studies have shown similar results after laparoscopic Nissen fundoplication compared with the open procedure . METHODS In a multicentre r and omised trial c and i date s for surgical treatment of GORD were r and omly assigned to either laparoscopic or open 360 degrees Nissen fundoplication . Primary endpoints were dysphagia , recurrent GORD , and intrathoracic hernia . Secondary endpoints were effectiveness and quality of life . This planned interim analysis focuses on endpoints and complications and in-hospital costs . FINDINGS At the time of interim analysis , 11 patients in the laparoscopic group and one in the conventional group had reached a primary endpoint ( p=0.01 ; relative risk=8.8 , 95 % CI 1.2 - 66.3 ) . This difference was caused mainly by whether or not patients had dysphagia ( seven patients in the laparoscopic group and none in the conventional group , p=0.016 ) . INTERPRETATION Although laparoscopic Nissen fundoplication was as effective as the open procedure in controlling reflux , the significantly higher risk of reaching a primary endpoint in the laparoscopic group led us to stop the study Background The laparoscopic approach has become increasingly popular for fundoplication over the last few years ; however many surgeons are skeptical about its real advantages . Methods We conducted a prospect i ve comparative study of children operated on for gastroesophageal reflux ( GER ) . Exclusion criteria included age < 1 year and > 14 years , previous surgery on the esophagus or stomach , and neurologic impairment . We compared two groups of patients who met the same inclusion /exclusion criteria . One group was treated via a  laparotomic approach between January 1993 and December 1997 ; the other was treated via a laparoscopic approach between September 1998 and December 2000 . A 360 ° wrap was performed in each group . Results Group 1 ( laparotomic approach  ) included 17 patients ; mean operative time was 100 min and postoperative time was 7 days . Group 2 comprised 49 children operated on via a laparoscopic approach ; mean operative time was 78 min and postoperative time was 48 hours . No major complications were encountered in either group . In postoperative period , two patients in group 1 had complications . One had a prolonged bout of gastroplegia , which required nasogastric drainage , and then recovered spontaneously after 20 days ; the other had stenosis of the wrap , which required dilation . No relapses occurred during a follow-up of 6 months . Longterm follow-up data are not presented . Comparative analysis of the short-term functional results indicated that there were no differences between the two groups . Conclusion This study confirms that the minimally invasive approach is safe and effective for the treatment of primary gastroesophageal reflux disease in children Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should be combined . This issue is the most serious method ological limitation . Even studies with statistically significant interaction might still be combined if the effect were in the same direction . Thus , substantial scientific input is required as to what criteria must be met by each potential study . Much can be learned from combining or pooling data but it must be done cautiously . Pooling exercises do not replace well design ed prospect i ve clinical trials . Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful . HYPOTHESIS Gastroesophageal reflux ( GER ) is a common condition in childhood that frequently requires operative treatment . The 360 degrees Nissen fundoplication ( NF ) has been the st and ard operation for GER , but is associated with substantial rates of recurrence , " gas bloat , " gagging , and dysphagia . I believe that the Toupet fundoplication ( TF ) , a 270 degrees posterior wrap originally described in conjunction with myotomy for achalasia , has fewer complications , and its longterm outcome in children compared with NF is favorable . DESIGN Nonr and omized controlled trial . SETTING Tertiary care children 's hospital . PATIENTS Two hundred fifty-six children ( aged 3 months to 16 years ) with GER disease unresponsive to nonoperative therapy who underwent either NF ( n = 102 ) or TF ( n = 154 ) . INTERVENTION Operative repair of GER disease by either NF or TF . MAIN OUTCOME MEASURES Time to first feeding , time to discharge from the hospital , postoperative dysphagia complications , recurrence , and rehospitalization and reoperation rates for each fundoplication technique . RESULTS The 2 fundoplication techniques had equivalent recurrence rates , but TF had significantly lower rates of postoperative dysphagia ( P = .008 ) and rehospitalization/reoperation rates ( P = .005 ) and significantly shorter times to discharge from the hospital ( P = .01 ) and to the first feeding ( P = .02 ) . CONCLUSIONS These data show that both NF and TF are effective procedures for GER in children , with acceptable recovery times and low recurrence rates . However , TF results in earlier feeding and discharge from the hospital and has a significantly lower incidence of dysphagia , gagging , and gas bloat , result ing in fewer rehospitalizations . In this population , TF seems to be superior to NF The use of the laparoscopic approach to perform antireflux procedures has increased dramatically since its introduction in 1991 . To date , no prospect i ve r and omized studies comparing open surgery to the minimal invasive approach  in children have been reported . Many retrospective review s and case series have demonstrated that laparoscopic antireflux procedures are safe and effective once the learning curve is achieved . This position paper is coauthored by the New Technology Committee of the American Pediatric Surgery Association . The goal is to discuss the ongoing controversies and summarize the available evidence to identify the risks and benefits of laparoscopic antireflux procedures OBJECTIVE The objective of this study was to determine whether a learning curve for laparoscopic fundoplication  can be defined , and whether steps can be taken to avoid any difficulties associated with it . SUMMARY BACKGROUND DATA Although early outcomes after laparoscopic fundoplication have been promising , complications unique to the procedure have been described . Learning curve problems may contribute to these difficulties . Although training recommendations have been published by some professional bodies , there is disagreement about what constitutes adequate supervised experience before the solo performance of laparoscopic antireflux surgery , and the true length of the learning curve . METHODS The outcome of 280 laparoscopic fundoplications undertaken by 11 surgeons during a 46-month period was assessed prospect ively . The experience was analyzed in three different ways : 1 ) by an assessment of the overall learning experience within chronologically arranged groups , 2 ) by an assessment of all individual experiences grouped according to the experience of individual surgeons , and 3 ) by a comparison of early outcomes of operations performed by the surgeons who initiated laparoscopic fundoplication with the early experience of surgeons beginning laparoscopic fundoplication later in the overall institutional experience . RESULTS The complication , reoperation , and laparoscopic to open conversion rates all were higher in the first 50 cases performed by the overall group , and in the first 20 cases performed by each individual surgeon . These rates were even higher in the initial first 20 cases , and the first 5 individual cases . However , adverse outcomes were less likely when surgeons began fundoplication later in the overall experience , when experienced supervision could be provided . CONCLUSIONS A learning curve for laparoscopic fundoplication can be defined . Experienced supervision should be sought by surgeons beginning laparoscopic fundoplication during their first 20 procedures . This should minimize adverse outcomes associated with an individual 's learning curve Objective : To compare the clinical outcome and endocrine response in children who were r and omized to open or laparoscopic Nissen fundoplication using minimization . Background : It is assumed that laparoscopic surgery is associated with less pain , quicker recovery and dampened endocrine response . Few r and omized studies have been performed in children . Methods : Parents gave informed consent , and this study was approved and registered ( Clinical Trials.gov Identifier : NCT00231543 ) . Anesthesia , postoperative analgesia and feeding were st and ardized 
    Output:
    
This systematic review and meta- analysis showed that reflux control is similar after both complete and partial fundoplication , while partial fundoplication significantly reduces the number of dilatations to treat severe dysphagia .