A comparison of laparoscopic Toupet versus Nissen fundoplication in gastroesophageal reflux disease

Abstract

Both partial and complete wrapping offer an effective form of therapy for reflux disease with over 85% patient satisfaction.

Nissen or partial posterior fundoplication: which antireflux procedure has a lower rate of side effects?

“…The rate of dysphagia after the Nissen fundoplication often reported in the recent literature is far below that found in our series of patients [14,24,28]. However, we believe that our study provides more realistic data, suggesting that the true rate of dysphagia following the Nissen fundoplication is much higher than often reported.…”

“…However, in a recent study, it has been emphasized that the type of fundoplication has no impact on postoperative side effects [23]. It also has been shown that the rate of persistent postoperative dysphagia is not increased if the Nissen fundoplication is performed in patients with poor oesophageal peristalsis [14,[23][24][25][26][27]. Moreover, it has been demonstrated that the Nissen fundoplication is more effective in controlling GERD than partial posterior fundoplication [26,27].…”

“…In several institutes a tailored approach of antireflux surgery is applied, with performance of the Nissen fundoplication in the case of normal oesophageal peristalsis and the partial posterior fundoplication in the presence of weak oesophageal peristalsis [4]. However, in recent studies, it has been considered that the rate of side effects following the Nissen fundoplication has been overestimated in the past, since it has not been significantly more than after partial posterior fundoplication [13,14]. The aim of this follow-up study was to investigate the rate of postoperative side effects following the Nissen fundoplication and following partial posterior fundoplication and to determine the influence of both procedures on oesophageal function.…”

Long-term experience of treating 185 patients with gastroesophageal reflux disease (GERD) by anti-reflux surgery respecting the functional–morphological restoration of the esophagus

“…Nissen fundoplication using a "floppy" 360°wrap is favored by most surgeons around the world, probably because it is easy to perform. The Toupet procedure, a partial posterior 270°wrap, was more recently reported to be as effective as the 360°Nissen procedure but associated with fewer postoperative problems [27][28][29][30][31]. The anatomical investigations of Stelzner and Lierse demonstrated why it is possible to control the gastroesophageal reflux by a fundoplication when the following requirements are fulfilled.…”

Laparoscopic antireflux surgery

“…The authors concluded that use of a prosthetic mesh reduces the risk of a recurrent hiatal hernia without any negative impact on patients' quality of life, even though postoperative dysphagia was temporarily higher in these patients. Quality-of-life data have also been used to compare the efficacy of laparoscopic Nissen (360 degree) fundoplication with that of laparoscopic Toupet (270 degree) fundoplication [16,32], showing that both procedures had similar improvement of quality of life.…”