Comparing Nissen-Rossetti and Floppy Nissen techniques in laparoscopic reflux surgery

Purpose: Gastroesophageal reflux disease (GERD) affects 13.98% of adults and is commonly linked to lower esophageal sphincter dysfunction. Symptoms include heartburn, regurgitation, and dysphagia. Initial therapy involves lifestyle measures and proton pump inhibitors, but many patients ultimately require surgery. Laparoscopic Nissen fundoplication remains the gold standard, though the optimal approach between Nissen-Rossetti and Floppy Nissen is debated. This study compared both techniques regarding operative parameters, complications, symptom control, and quality of life.Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Ovid Medline, Ovid Cochrane, and Scopus were searched for studies reporting demographic, operative, and outcome data. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized trials and the MINORS index for non-randomized studies. Pooled analyses were conducted with random- and fixed-effects models in RevMan.Results: Twelve studies involving 1,165 patients were included: 320 underwent Nissen-Rossetti and 600 Floppy Nissen. Nissen-Rossetti demonstrated shorter operative times (mean difference –25.29 minutes, P < 0.00001) but was associated with higher esophageal dilation (16.3% vs. 4.4%; odds ratio [OR], 3.58; P = 0.0002) and dysphagia (25.1% vs. 15.6%; OR, 1.87; P = 0.009). Floppy Nissen showed shorter hospital stays (mean difference –0.18 days, P = 0.01), with comparable symptom resolution.Conclusion: The Floppy Nissen procedure offers superior postoperative outcomes, fewer complications, and shorter hospitalizations compared with Nissen-Rossetti. Additional randomized trials are needed to confirm these findings.