The Pros and Cons of Partial Versus Total Fundoplication for Gastroesophageal Reflux Disease

Laparoscopic Nissen fundoplication is currently the most commonly performed procedure for gastroesophageal reflux disease (GERD). In patients with inefficient esophageal motility, a partial fundoplication such as a Toupet 270-degree posterior fundoplication is often recommended. There is controversy as it relates to the necessity of this tailored approach to fundoplication. There is also debate when it comes to the suitability and even the superiority of a partial compared to a full fundoplication. There are numerous randomized controlled trials and meta-analyses of these trials to guide the debate. From the evidence, it would appear that a full and a partial fundoplication are associated with similar GERD-related outcomes and that a partial fundoplication is associated with fewer side effects such as bloating and dysphagia.