A comparison of laparoscopic Toupet versus Nissen fundoplication in gastroesophageal reflux disease

Background and aims: Laparoscopic Nissen fundoplication is used very frequently but may lead to postoperative bloating, inability to belch, and dysphagia. Partial wrapping has been reported to be equally effective but associated with fewer unfavorable postoperative symptoms. The aim of this retrospective analysis was to compare the results of a 270 wrap (Toupet, T) and a 360 wrap (Nissen, N) in patients with gastroesophageal reflux disease (GERD). Patients/methods: A total of 162 patients with severe GERD and/or hiatal hernia underwent laparoscopic antireflux surgery between January 1997 and December 2000. All patients were assigned to the T group before January 2000; after January 2000, they were assigned to either the T or the N group depending on preexisting motility disorders. The pre- and postoperative gastrointestinal quality of life index (GIQLI) was assessed. Results: A total of 122 patients were treated using the T procedure, and 40 patients underwent N fundoplication; 124 patients (77%) had a lower esophageal sphincter (LES) pressure of less than 15 mmHg, and 34 (21%) had a low esophageal body peristaltic pressure of less than 35 mm Hg. All of the latter 34 had undergone partial fundoplication. The average operation time was 140+/-5 min in the T group and 118+/-6 min in the N group (P=0.03). Postoperative hospitalization averaged 3.8 days in the T group and 3.4 days in the N group. Operative complications only occurred in the T group (2%), and none of the patients died. No statistical difference was seen preoperatively or at follow-up (mean 19 months; range 4-36 months) between the quality of life score after partial versus complete wrapping (88 and 123 in the T group, 87 and 118 in the N group preoperatively and at follow-up, respectively). Conclusions: Both partial and complete wrapping offer an effective form of therapy for reflux disease with over 85% patient satisfaction.