Introduction. It remains debatable whether a partial or complete fundoplication will afford the best control of reflux with fewest side effects. This study compares prospectively the outcome of floppy Nissen (3600) and Toupet partial (1800) laparoscopic fundoplication.
Patients and methods. 72 consecutive patients with severe GERD were randomised to laparoscopic floppy Nissen (40 pts, N) or Toupet (32 pts, T) groups. The patients underwent endoscopy, esophageal manometry and 24h pH-monitoring preoperatively and 3 months and 2 years after the operation. In Nissen fundoplication, a 2 cm floppy wrap with severance of the short gastric vessels was constructed. In Toupet fundoplication, the dorsal wrap was created using 12 unresorbable stiches. The degree of preoperative esophagitis was similar, as were the Visick scores and incidence of dysphagia. In the N and T groups, respectively, the mean age was 52±2 vs 49±2 yrs, BMI 27±0.6 vs 27±0.6 kg/m2 and duration of symptoms 9±2 vs 10±2 yrs.
Results. The duration of the operation was significantly longer in Toupet procedure, 106±3.4 vs 92±3.8 min (p=0.01). There were no major complications, hospital mortality or conversions to open surgery. The mean postoperative hospital stay was 3.1±0.5 (N) vs 3.2±0.8 (T) days. Immediate belching ability was better in T group, 32 (100%) vs 30 (75%) pts (p=0.004). 3 T and 3 N pts had gas bloat, while 1 T and 5 N pts had persistent dysphagia. After two years 2 T and 4 N wraps were partially ruptured. At 3 months excellent/good Visick scores were equal (93% N vs 96% T), but at 2 yrs significantly poorer in T group (Table).
Conclusions. The early outcome of Toupet fundoplication is equal to that of Nissen procedure, but seems to become worse with time.
Preoperative and 2-year postoperative results after fundoplication (mean±SEM)
Nissen preop Nissen 2yrs Toupet preop Toupet 2yrs
LES-pressure (mmHg) 8.3±0.7 15.8±1.1* 10.0±0.8 17.0±1.3*
DeMeester score 48.7±4.1 23.7±8.1* 46.3±6.3 14.5±0.4*
Visick excell/good (%) 91 79
*p<0.05 vs preop value
p<0.05 vs Nissen group
