Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility
- 20 November 2007
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 22 (1), 21-30
- https://doi.org/10.1007/s00464-007-9546-8
Abstract
To determine the influence of preoperative esophageal motility on clinical and objective outcome of the Toupet or Nissen fundoplication and to evaluate the success rate of these procedures. Nissen fundoplication (360°) is the standard operation in the surgical management of gastroesophageal reflux disease (GERD). In order to avoid postoperative dysphagia it has been proposed to tailor antireflux surgery according to pre-existing esophageal motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and it has been recommended to use the Toupet procedure (270°) in these patients. We performed a randomized trial to evaluate this tailored concept and to compare the two operative techniques concerning reflux control and complication rate (dysphagia). 200 patients with GERD were included in a prospective, randomized study. After preoperative examinations (clinical interview, endoscopy, 24-hour pH-metry and esophageal manometry) 100 patients underwent either a laparoscopic Nissen procedure (50 with and 50 without motility disorders), or Toupet (50 with and 50 without motility disorders). Postoperative follow-up after two years included clinical interview, endoscopy, 24-hour pH-metry, and esophageal manometry. After two years 85% (Nissen) and 85% (Toupet) of patients were satisfied with the operative result. Dysphagia was more frequent following a Nissen fundoplication compared to Toupet (19 vs. 8, p < 0.05) and did not correlate with preoperative motility. Concerning reflux control the Toupet proved to be as good as the Nissen procedure. Tailoring antireflux surgery according to the esophageal motility is not indicated, as motility disorders are not correlated with postoperative dysphagia. The Toupet procedure is the better operation as it has a lower rate of dysphagia and is as good as the Nissen fundoplication in controlling reflux.Keywords
This publication has 53 references indexed in Scilit:
- Ambulatory long-term pH monitoring in pigsSurgical Endoscopy, 2003
- Laparoscopic vs open approach for Nissen fundoplicationSurgical Endoscopy, 2002
- Nissen vs Toupet laparoscopic fundoplicationSurgical Endoscopy, 2002
- Oesophageal dysmotility is not associated with poor outcome after laparoscopic Nissen fundoplicationBritish Journal of Surgery, 1998
- Tailored augmentation of the lower esophageal sphincter in experimental antireflux operationsSurgical Endoscopy, 1997
- Laparoscopic partial fundoplication vs laparoscopic Nissen-Rosetti fundoplicationSurgical Endoscopy, 1997
- Laparoscopic ‘physiological’ antireflux procedure: Preliminary results of a prospective symptomatic and objective studyBritish Journal of Surgery, 1995
- Laparoscopic Nissen fundoplication: Technique and preliminary resultsBritish Journal of Surgery, 1994
- Study of belching ability in antireflux surgery patients and normal volunteersBritish Journal of Surgery, 1991
- A Long-Term Randomized Prospective Trial of the Nissen Procedure Versus a Modified Toupet TechniqueAnnals of Surgery, 1989