Standards of laparoscopic fundoplication

During the last 3 years laparoscopic Nissen fundoplication became the standard laparoscopic procedure for treating gastroesophageal reflux disease. Exact preoperative diagnosis (24-hour pH manometry and upper gastrointestinal endoscopy with biopsy) is mandatory for surgery indication and operative treatment. 360 degrees 'floppy' Nissen fundoplication, laparoscopically performed, is the treatment of first choice. Partial fundoplication (i.e. Toupet) should be carried out only if the pressure of the lower esophageal sphincter shows normal values and/or esophageal motility disorders are pre sent. Partial Dor fundoplication shows no benefit and should be performed only if esophageal motility disorders are present. In the near future, randomized trials will answer the question if partial Toupet fundoplication shows significant advantages over total Nissen fundoplication in terms of decreased morbidity.