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Related Experiment Videos

Nissen vs Toupet laparoscopic fundoplication.

C Zornig1, U Strate, C Fibbe

  • 1Department of General Surgery, Israelitisches Krankenhaus, Orchideenstieg 14, 22297 Hamburg, Germany.

Surgical Endoscopy
|May 9, 2002
PubMed
Summary

The Toupet procedure is recommended over Nissen fundoplication for gastroesophageal reflux disease (GERD) surgery. It offers similar reflux control with significantly less postoperative dysphagia, regardless of preoperative esophageal motility.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Patient Outcomes

Background:

  • Nissen fundoplication (360°) is standard for gastroesophageal reflux disease (GERD).
  • Tailoring surgery based on esophageal motility aims to reduce postoperative dysphagia.
  • The Toupet procedure (270°) is suggested for patients with motility disorders.

Purpose of the Study:

  • To compare Nissen vs. Toupet fundoplication for GERD.
  • To evaluate the impact of preoperative esophageal motility on surgical outcomes.
  • To assess reflux control and dysphagia rates for both procedures.

Main Methods:

  • Prospective randomized trial of 200 GERD patients (1999-2000).
  • Preoperative assessment included clinical interview, endoscopy, 24-h pH study, and esophageal manometry.

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  • Patients underwent laparoscopic Nissen or Toupet, with follow-up at 4 months.

    • Main Results:

    • Patient satisfaction was high for both procedures (88% Nissen, 90% Toupet).
    • Dysphagia was significantly more frequent after Nissen fundoplication (30%) than Toupet (11%, p <0.001).
    • Reflux control was comparable between the Nissen and Toupet procedures.

    Conclusions:

    • Tailoring antireflux surgery to esophageal motility is not indicated.
    • The Toupet procedure is superior due to lower dysphagia rates.
    • Both procedures effectively control reflux, but Toupet offers better safety regarding dysphagia.