Toupét fundoplication for gastroesophageal reflux in childhood

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Outcomes

Background:

• Gastroesophageal reflux (GER) is common in children and often requires surgical intervention.
• The 360-degree Nissen fundoplication (NF) is a standard but complication-prone procedure for GER.
• The 270-degree Toupet fundoplication (TF) is proposed as a potentially safer alternative.

Purpose of the Study:

• To compare the long-term outcomes and complication rates of Toupet fundoplication (TF) versus Nissen fundoplication (NF) in pediatric patients with GER disease.
• To evaluate the efficacy of TF in reducing postoperative complications such as dysphagia, gagging, and gas bloat compared to NF.

Main Methods:

• A nonrandomized controlled trial was conducted at a tertiary care children's hospital.
• Two hundred fifty-six children with GER disease unresponsive to nonoperative therapy underwent either NF (n=102) or TF (n=154).
• Key outcome measures included time to first feeding, hospital discharge, postoperative dysphagia, recurrence, and rehospitalization/reoperation rates.

Main Results:

• Both NF and TF demonstrated equivalent recurrence rates for GER.
• TF showed significantly lower rates of postoperative dysphagia (P=.008) and rehospitalization/reoperation (P=.005).
• Children undergoing TF experienced significantly shorter times to first feeding (P=.02) and hospital discharge (P=.01).

Conclusions:

• Both Nissen fundoplication and Toupet fundoplication are effective in managing pediatric GER disease with acceptable recovery and low recurrence.
• Toupet fundoplication is associated with significantly fewer complications, including dysphagia, gagging, and gas bloat.
• TF appears to be a superior surgical option for GER in children, leading to earlier feeding, shorter hospital stays, and reduced rehospitalizations.