Total versus partial fundoplication in children with gastroesophageal reflux disease: a systematic review and comparative meta-analysis of 2633 patients highlighting the trade-off between reflux control and postoperative dysphagia

Clinical Snapshot

Key Findings

• P Value: p = 0.024

• Effect Size: RR 1.69 (95% CI 1.07-2.68)

• Primary Outcome: Postoperative dysphagia significantly higher with total fundoplication

• Nnt Or Sensitivity: NNH = 17 for dysphagia; NNT = 15 for reflux prevention (non-significant)

• Confidence Interval: 95% CI 1.07-2.68

Clinical Application

Both procedures are standard of care in pediatric surgery centers with appropriate expertise Relevant to Australian pediatric surgery practice; procedures covered under Medicare with appropriate indications; aligns with RACS guidelines for pediatric antireflux surgery Children with medically refractory GERD requiring surgical intervention

Abstract

INTRODUCTION: Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention when medical therapy fails. Nissen (total) and Toupet (partial) fundoplications are the most frequently performed antireflux procedures; however, their comparative effectiveness and safety in the pediatric population remain uncertain. METHODS: A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL from database inception to 2025. Eligible studies included randomized controlled trials and observational studies comparing total and partial fundoplication in patients younger than 18 years with GERD. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models in R software. RESULTS: Eighteen studies including 2,633 children were analyzed. Total fundoplication was associated with a significantly higher risk of postoperative dysphagia compared with partial fundoplication (RR 1.69; 95% CI 1.07-2.68; p = 0.024; I²=12%; n = 1,154), corresponding to an absolute risk increase of 5.7% and a number needed to harm (NNH) of 17. No significant difference was observed in reflux recurrence (RR 0.72; 95% CI 0.21-2.42; p = 0.59; I²=71% n = 834), although event rates were numerically lower after total fundoplication (6.8% vs. 13.7%), corresponding to an absolute risk reduction of 6.9% (NNT = 15). Intraoperative complications (RR 1.11; p = 0.84), postoperative complications (RR 1.49; p = 0.12), reoperation rates (RR 0.95; p = 0.88), and mortality (RR 1.09; p = 0.74) were comparable between procedures. CONCLUSIONS: Total and partial fundoplication demonstrate similar effectiveness for reflux control and overall safety in pediatric GERD. However, total fundoplication is associated with a higher risk of postoperative dysphagia, suggesting that partial fundoplication may offer functional advantages in selected patients.

References

1. 1.Fonseca, P. E., Amador, W. F., Scremin, G. M., Mena, L. H., Mayer, S., Nijampurkar, N., & Pimpalwar, A. (2026). Total versus partial fundoplication in children with gastroesophageal reflux disease: a systematic review and comparative meta-analysis of 2633 patients highlighting the trade-off between reflux control and postoperative dysphagia. Pediatric Surgery International. https://doi.org/10.1097/MD.0000000000008085