Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux

The importance of the extent of the fundic wrap that encircles the distal oesophagus for the establishment of long-term control-of gastro-oesophageal reflux disease (GORD) and for the risk of symptoms after fundoplication was evaluated ill a prospective, randomized clinical trial, Of 137 consecutive patients with GORD, 72 were allocated to a semifundoplication (180-200 degrees, Toupet) and 65 tea: total fundoplication (360 degrees, Nissen-Rossetti)I Dysphagia was more common in the early postoperative period after a total fundic wrap, a difference which disappeared with time. This corresponded to a higher resting tone in th lower oesophageal sphincter area. Seven patients (5 percent) experienced relapse of GORD during follow-up of of more than 3 gears. Although no re difference in the cumulative: relapse rate (5 per cent for Nissen-Rossetti versus 6 per cent for Toupet) was found between the two study groups, the total failure rate was higher (P < 0.05) among patients who had a Nissen-Rossetti procedure because of a procedure-specific complication: intrathoracic herniation of the fundoplication in five patients caused obstructive symptoms without reflux (four had no posterior crural repair). in. addition, symptoms in the form of flatulence were more frequently seen after Nissen-Rossetti fundoplication (P < 0.05 at 2 years and P < 0.01 at 3 years), Both Nissen-Rossetti and Toupet fundoplication equally well and durably controlled GORD, Few er symptoms occurred in those having a semifundoplication, both in the early and late postoperative period.