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Related Experiment Video

Updated: Nov 19, 2025

Robotic Myotomy and Partial Fundoplication for Achalasia
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Complete vs partial fundoplication: a laboratory measurement of functionality and effectiveness.

Rachel Gefen1, Gad Marom1, Ronit Brodie1

  • 1Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Minimally Invasive Therapy & Allied Technologies : MITAT : Official Journal of the Society for Minimally Invasive Therapy
|February 2, 2021
PubMed
Summary

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Nissen and Toupet fundoplication show similar mechanical functionality for GERD treatment, with Toupet offering fewer post-operative complications. This study supports Toupet as a viable alternative to Nissen fundoplication.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Biomechanical Engineering

Background:

  • Fundoplication is a surgical approach for GERD, with complete and partial methods debated.
  • Partial fundoplication may have fewer side effects like dysphagia but is often less effective.
  • Comparing mechanical properties of different fundoplication types is crucial for optimizing GERD treatment.

Purpose of the Study:

  • To evaluate and compare the mechanical efficiency of three fundoplication techniques: Nissen, Toupet, and Dor.
  • To assess the distensibility and failure points of the esophagogastric junction (EGJ) after different fundoplication procedures.

Main Methods:

  • Explanted human stomachs were used to study the lower esophageal sphincter (LES) mechanical properties.
  • Distensibility and failure point measurements were conducted before and after Nissen, Toupet, and Dor fundoplications.
Keywords:
GERDcomplete fundoplicationdistensibilitydysphagiapartial fundoplicationreflux

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  • Statistical analysis was performed to compare the mechanical outcomes between the three surgical techniques.

    • Main Results:

    • No significant difference in EGJ distensibility was observed between Nissen and Toupet fundoplications.
    • Dor fundoplication resulted in a more distensible EGJ compared to Nissen and Toupet.
    • Nissen fundoplication demonstrated the highest failure point, followed by Toupet, and then Dor, indicating significant differences in mechanical strength.

    Conclusions:

    • While Dor fundoplication affects EGJ distensibility differently, Nissen and Toupet exhibit similar mechanical functionality.
    • Significant differences in mechanical effectiveness were found among all three fundoplication types based on failure point analysis.
    • These biomechanical findings suggest Toupet fundoplication is a mechanically sound alternative to Nissen, potentially offering better clinical outcomes due to fewer complications.