A Chinese randomized prospective trial of floppy Nissen and Toupet fundoplication for gastroesophageal disease

Abstract

LTF seems to be as safe and effective on the long-term as LNF, but with a lower incidence of postoperative dysphagia (ChiCTR-TRC-13003945).

Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication

“…Mild dysphagia is relatively usual in the direct postoperative phase and improves as the mucosal edema and/or hematoma of the wrap subside. Instead, PD is infrequent, but occurs up to 20% and represents a challenge in further treatment [4, 9, 10]. It has been shown that the presence of preoperative dysphagia and IEM, certain preoperative LES characteristics and surgical technique have an influence in the development of PD [9, 10, 25].…”

“…Although there is no clear consensus on the ideal fundoplication, lower PD rates have been observed in patients who underwent TF instead of LNF [8, 10, 15]. Furthermore, TF is the current treatment of choice in patients with IEM, in order to avoid PD [8].…”

“…Studies have shown that not only the type of fundoplication, but also the length of the wrap effects the prevalence of PD. Thus, the policy of a thin Nissen sleeve, measuring not longer than 1.5–2 cm has been established [10, 26]. …”

“…Two of the patients were diagnosed preoperatively with IEM, which has been described as a risk factor for postoperative PD [8, 13]. Although previous studies have demonstrated lower PD rates after partial fundoplication, making it the preferred surgical approach in patients with IEM [8, 10, 15], available evidence suggests that the outcomes of patients with IEM are not affected by the type of fundoplication [46–49]. We confirm these findings as no significant difference was found in postoperative PD rates when compared between the two subgroups ( n  = 2, 3% vs. n  = 6, 2%, χ 2  = 0.298, p  = 0.585).…”

“…In an effort to reduce PD rates while maintaining effective reflux control alterations of the standard Nissen fundoplication have been developed over time [10]. Such modifications involve partial 270° Toupet fundoplication (TF) or anterior 120° Dor fundoplication (DF) [10, 15].…”