Thal versus Nissen fundoplication for the management of pediatric gastroesophageal reflux disease: a systematic review and meta-analysis.

Background: Gastroesophageal reflux disease (GERD) in children is a common condition associated with significant morbidity. Surgery, particularly fundoplication, is performed when conservative management fails. Nissen fundoplication (NF) has been established as the gold standard for surgical management of GERD, but Thal fundoplication (TF) is an alternative that may carry less risk. This systematic review and meta-analysis aimed to compare the efficacy and safety of TF and NF in children diagnosed with GERD. Methods: A comprehensive literature search was conducted through different databases, such as PubMed, Scopus, Web of Science, and Cochrane CENTRAL. Studies that directly compared TF and NF in pediatric populations were eligible. Data were extracted using a standardized data extraction sheet and analyzed using R software. Results: Fifteen studies were included, comparing TF (n = 624) and NF (n = 1260). There was no significant difference in recurrence rates between the two groups (OR 1.23, 95% CI: 0.81-1.85, Conclusion: TF effectively manages pediatric GERD, with reflux control outcomes comparable to NF. TF had lower dysphagia rates. Our findings suggest that TF may be a suitable alternative to NF in children with neurological impairments. Further high-quality, randomized controlled trials are needed to confirm these results and accurately define each procedure's indications.