A Clinical Comparison of Laparoscopic Nissen and Toupet Fundoplication for Gastroesophageal Reflux Disease

Abstract

In the short term, the incidence of dysphagia was significantly lower after Toupet fundoplication, but the difference decreased significantly with extension of the postoperative recovery period. For patients with moderate to severe GERD, the laparoscopic Nissen fundoplication may be optimal; for elderly patients or for patients with significantly reduced esophageal peristalsis detected in preoperative examinations, the laparoscopic Toupet fundoplication should be considered.

A Meta-Analysis of Randomized Controlled Trials to Compare Long-Term Outcomes of Nissen and Toupet Fundoplication for Gastroesophageal Reflux Disease

“…Finally, the literature search identified 13 RCTs [ 6 , 7 , 12 , 15 – 17 , 19 , 20 – 25 ] published between June 1997 and July 2013. A total of 814 (52.05%) patients underwent LNF and 750 (47.95%) patients underwent LTF.…”

“…Seven trials [ 6 , 12 , 15 , 17 , 19 , 21 , 25 ] reported mean operative time ( S2 Fig ), which ranged from 35.5 [ 15 ] to 155 [ 19 ] min in the LNF group and 32.5 [ 15 ] to 162 [ 19 ] min in the LTF group. Operative duration was shorter in the LNF group, but no significant difference was found between groups (LNF vs. LTF, standard mean difference -0.45, 95% CI [-1.00, 0.11], p = 0.11).…”

“…Operative duration was shorter in the LNF group, but no significant difference was found between groups (LNF vs. LTF, standard mean difference -0.45, 95% CI [-1.00, 0.11], p = 0.11). Four trials reported mean hospital stay in both groups, which ranged from 2.6 [ 12 ] to 3.8 [ 17 ] days in the LNF group and from 2.5 [ 19 ] to 4.2 [ 17 ] days in the LTF group.…”

“…However, a comprehensive study collecting randomized clinical trials (RCTs) has not been conducted to date. In recent years, several studies with large sample sizes and recent follow-up data have been published comparing long-term efficacy and adverse events of both total and partial fundoplication [ 7 , 15 – 17 ]. Therefore, in order to better weigh the potential benefits against the potential side effects, data from these recent trials is now timely to be re-evaluated and synthesized with the existing trials.…”

Outcomes of redo surgery for failed laparoscopic fundoplication

“…Many articles comparing the outcomes of laparoscopic Nissen and Toupet fundoplication have been published [20][21][22][23][24]. In the current study, in terms of indications for redo-ARS, the most common cause of failure of the prior ARS was dislocation of the wrap and recurrence of the hiatal hernia.…”