Laparoscopic partial posterior (Toupet) fundoplication improves esophageal bolus propagation on scintigraphy

Wykypiel, Heinz; Hugl, Beate; Gadenstaetter, Michael; Bonatti, Hugo; Bodner, Johannes; Wetscher, Gerold J.

doi:10.1007/s00464-007-9719-5

Cited by 23 publications

(18 citation statements)

References 30 publications

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“…Interestingly, fundoplication normalized scintigraphy in one third of patients with abnormal preoperative esophageal transit times and in two thirds of patients with abnormal preoperative gastric emptying studies (Table 1). Such functional improvements in esophageal and gastric motility after fundoplication have been documented previously in several studies [33][34][35][36]. These data suggest a functional benefit of abrogating chronic reflux and restoring a lower esophageal high-pressure zone.…”

Section: Discussionsupporting

confidence: 79%

The use of esophageal transit and gastric emptying studies in the evaluation of patients undergoing laparoscopic fundoplication

et al. 2010

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Nuclear scintigraphic assessment of esophageal transit and gastric emptying are valuable, user-friendly tools to identify and avoid functional motility problems in the setting of fundoplication. These studies seem to be a reasonable alternative to manometry in assessing esophageal function before surgery in this setting. Postoperative symptoms may be related to objective changes in esophageal transit or gastric emptying. The causes may be iatrogenic in nature or related to vagal denervation with associated changes in esophagogastric compliance. Awareness of these physiologic changes may prompt further technical precautions at the time of surgery to avoid vagal injury and also may facilitate postoperative medical management.

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Section: Discussionsupporting

confidence: 79%

The use of esophageal transit and gastric emptying studies in the evaluation of patients undergoing laparoscopic fundoplication

et al. 2010

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“…Moreover, in our studies [2,3] we were even able to demonstrate an improvement of former impaired esophageal motility in the Toupet group, while this was not found in the Nissen group. In our study, there was a strong correlation between postoperative dysphagia and impaired postoperative lower esophageal sphincter (LES) relaxation (Spearman correlation; r s = -0.75 at a p value \0.05) and the same was true for bloating (r s = -0.71), inability to belch (r s = -0.82), inability to vomit (r s = -0.86), and epigastric pain (r s = -0.68).…”

Section: Dear Sirscontrasting

confidence: 41%

On: Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility [Surg Endosc 22(1):21–30]

Wykypiel

Wetscher

2008

Surg Endosc

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Dear sirs,We read with great interest the recent publication entitled ''Laparoscopic fundoplication: Nissen versus Toupet twoyear outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility'' [1].We already published in 2005 an analysis of our patients operated within the so-called tailored approach on 209 patients with a median follow-up of 52 months [2]. We compared those patients without recurrence regarding their long-term symptoms and their functional results and came to the same conclusion as the authors of the above mentioned publication.The laparoscopic partial posterior (Toupet) fundoplication seems to be the better operative procedure for the treatment of gastroesophageal reflux disease (GERD).It has a lower rate of side effects, nota bene less dysphagia and, given the appropriate technique, it restores the antireflux barrier to the same extent as the Nissen fundoplication [2]. Moreover, in our studies [2, 3] we were even able to demonstrate an improvement of former impaired esophageal motility in the Toupet group, while this was not found in the Nissen group. In our study, there was a strong correlation between postoperative dysphagia and impaired postoperative lower esophageal sphincter (LES) relaxation (Spearman correlation; r s = -0.75 at a p value \0.05) and the same was true for bloating (r s = -0.71), inability to belch (r s = -0.82), inability to vomit (r s = -0.86), and epigastric pain (r s = -0.68). In other words, the Nissen fundoplication may lead to an impairment of the LES relaxation often to an extent like in achalasia, while this was not seen after a Toupet fundoplication; so we concluded that an impaired relaxation could be the main cause of this problem.

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“…The degree of increasing pressure increase after fundoplication is usually dependent on the type of plasty: 14 Nissen repairs produce a higher LES pressure in comparison to posterior repairs, although the difference is not statistically significant. The results after anterior repair (Watson) in terms of LES resting and residual pressure and in terms of transient relaxations are similar to Nissen repair and unrelated to body position and gastric distension 15,16 …”

Section: What Is the Effect Of The Various Ar Procedures On The Les?mentioning

confidence: 81%

Barrett's esophagus: surgical treatments

Rosati

Savarino

Locatelli

et al. 2011

Annals of the New York Academy of Sciences

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The following on surgical treatments for Barrett's esophagus includes commentaries on the indications for antireflux surgery after medical treatment; the effects of the various procedures on the lower esophageal sphincter; the role of impaired esophageal motility and delayed gastric emptying in the choice of the surgical procedure; indications for associated highly selective vagotomy, duodenal switch, and gastric electrical stimulation; therapeutic strategies for detection and treatment of shortened esophagus; the role of antireflux surgery on the regression of metaplastic mucosa and the risk of malignant progression; the detection of asymptomatic reflux brfore bariatric surgery; the role of non-GERD symptoms on the results of surgery; and the indications of Collis gastroplasty and choice of the type of fundoplication.

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Laparoscopic partial posterior (Toupet) fundoplication improves esophageal bolus propagation on scintigraphy

Abstract: Laparoscopic partial posterior (Toupet) fundoplication can restore a preoperatively defective esophageal bolus propagation on scintigraphy with the same antireflux effect as the laparoscopic Nissen fundoplication, but with lower side-effects.

Cited by 23 publications

References 30 publications

The use of esophageal transit and gastric emptying studies in the evaluation of patients undergoing laparoscopic fundoplication

The use of esophageal transit and gastric emptying studies in the evaluation of patients undergoing laparoscopic fundoplication

On: Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility [Surg Endosc 22(1):21–30]

Barrett's esophagus: surgical treatments

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