Fundoplication: cases vs. RCT

The Health Technology Assessment Programme published its findings on laparoscopic fundoplication for chronic gastroeaophageal reflux disease in September 20081. “The results showed that surgical treatment was more effective than long-term drug therapy, especially in patients with the most troublesome symptoms, certainly up to one year after the procedure. A surgical policy is, however, more costly than medical management and it is uncertain whether it would be cost-effective in the long-term.”

The BBC, in a recent news article2, cite a case where a young woman’s quality of life was greatly improved by the operation.

There is clearly enthusiasm for the long term success (and therefore cost-effectiveness) of this procedure from the authors of the study and other experts cited by the BBC. The use of a case report here is trying to push forward the debate ahead of results from the extended follow-up from the trial.

I don’t think the case reports are going to change clinical practice more than the final results of the RCT in this battle but they can certainly keep the message of the benefit for severe cases alive in the meantime.

1) Grant A. The effectiveness and cost-effectiveness of minimal access surgery amongst people with gastro-oesophageal reflux disease – a UK collaborative study. The REFLUX trial. Health Technol Assess 2008;12(31):1–214

2) Elliot J. ‘I can eat pizza again after 10 years’. BBC News: Health. Available online at (accessed 13 April 2009)