Introduction: Laparoscopic Toupet (270° partial) fundoplication (LT) may have fewer post-operative side effects when compared with Nissen (360°) fundoplication (LN). Aim: To evaluate long-term outcome after LT and LN fundoplication in patients with gastro-oesophageal reflux disease (GORD). Methods: We previously reported results for 100 patients with PPI dependent GORD who were randomized to either LT or LN fundoplication1. Oesophageal manometry, 24-hour pH studies and a detailed symptom questionnaire were completed pre- and 3 months post procedure in all patients. Visual analogue symptom (VAS) scores were assessed annually thereafter. In February to March 2005 we telephonically contacted patients for an outcome questionnaire a mean of 6 years (range 2.5-8 yrs) after initial intervention. Patients were asked whether they would recommend surgery to others, whether they would undergo the procedure again and whether they felt they were better than before the surgery. Student T, Wilcoxin and Fisher exact tests were performed as appropriate. Results: We reached 73 of the initial cohort (3 had died and 24 were lost to follow-up). In the LN group 33/37 would recommend surgery, 32/37 would have repeat surgery and 34/37 felt they were better despite 8 patients still requiring PPI’s and 3 undergoing redo-surgery. The corresponding numbers for the LT group were 35/36, 30/36, and 33/36 with 2 on PPI’s and 3 requiring redo-surgery. None of these parameters were statistically different between the two groups (p= 0.9, 1.0, 1.0, 0.07, 1.0 respectively). At 3 months, there were no differences for symptoms and physiological variables except lower oesophageal pressure (LOSP) was higher in the LN group (16.1 vs. 12.8 mmHg, p= 0.04) increasing by a mean of 12 vs. 4.8mmHg (p=0.03). There was significant improvement post procedure within each group with respect to LOSP, lower oesophageal sphincter length (LOSL), % time pH < 4.0, De Meester score and VAS scores of heartburn, regurgitation and flatulence. The gasbloat VAS score decreased post-procedure in the LT group [p=0.009], but was no different in the LN group. When we restricted the definition of GORD to a distal pH exposure of <4 for >4.2% of time and/or erosive oesophagitis grade B-D (n=69), there were no significant differences between the groups. Conclusion: Patients undergoing both LN and LT are generally happy with their surgery despite 13.6% still requiring PPI’s and 8.2% requiring redo surgery. There do not appear to be any long-term differences in outcome between LN and LT despite LN achieving a higher LOSP at 3 months. Reference: 1. SAMJ 2004, 94(8); 675