Background: The Nissen, or total, fundoplication has been demonstrated to be highly efficacious in the management of gastroesophageal reflux disease (GERD). However, studies have also shown that its clinical efficacy is compromised by a relatively high frequency of digestive complaints. The Toupet, or posterior partial, fundoplication results in a lower incidence of postoperative digestive complaints, but may be associated with suboptimal control of GERD symptoms. In the current study, our aim was to report our institutional series of Nissen and Toupet fundoplications and to compare the outcomes of these procedures with regard to relief of GERD symptoms and the frequency of postoperative digestive complaints. Methods:We identified 92 patients with normal esophageal motility who underwent either Nissen (n = 57) or Toupet (n = 35) fundoplication from 1992 to 1998 at our institution. Preoperative, intraoperative, and postoperative clinical parameters were examined. To assess quality of life outcomes, the Gastroesophageal Reflux Disease-Health Related Quality of Life questionnaire and the Standard SF-36 Quality of Life questionnaire were administered via telephone survey. Statistical comparisons were performed by the Mann-Whitney rank sum test. Results:The two groups were similar regarding demographic data, preoperative clinical symptoms, and duration of gastroesophageal reflux disease. The severity of postoperative heartburn symptoms and dysphagia symptoms did not differ between the two groups over a mean follow-up period of 8.7 years. Patients who underwent Nissen fundoplication had a significantly higher frequency of postoperative gas-bloat symptoms compared to those who underwent Toupet fundoplication (p < 0.05). Conclusions:Both Nissen and Toupet fundoplication control GERD symptoms equally well. Postoperative gas-bloat symptoms are more frequent following total fundoplication than after posterior partial fundoplication. These data corroborate the findings of other recent studies that Toupet fundoplication offers a similar level of GERD symptom control with fewer postoperative digestive complaints.