Comparative study between the effect of Nissen fundoplication and Toupet fundoplication on postoperative manometry...

Gastro-esophageal reflux disease (GERD) impairs quality of life and may require surgery when medical treatment fails. Laparoscopic Nissen fundoplication (LNF) is the traditional gold-standard, whereas laparoscopic Toupet fundoplication (LTF) may provide comparable reflux control with fewer motility-related side-effects.

We conducted a single-center, parallel-group, randomized controlled trial (ClinicalTrials.gov identifier: NCT05432109) at Ain Shams University Hospitals. Twenty adults with medically refractory GERD were randomized (1:1) to LNF or LTF. Primary outcome was change in lower esophageal sphincter (LES) pressure measured by high-resolution manometry (HRM) 6 weeks post-operatively. Secondary outcomes included distal contractile integral (DCI), largest break size, distal latency (DL), hiatus hernia resolution, GERD Health-Related Quality of Life (GERD-HRQL) score, and adverse events. Analyses followed CONSORT guidelines and utilized an intention-to-treat approach.

Both procedures significantly increased median LES pressure (LNF: + 12 mmHg; LTF: + 10 mmHg, p < 0.001 each). LTF produced greater improvement in largest break size (- 1.60 cm vs. - 1.00 cm; p = 0.013) and GERD-HRQL (median reduction - 3 vs. - 2; p = 0.019). DCI rose more after LTF (+ 710 vs. + 225 mmHg s cm; p = 0.051). Early dysphagia occurred in 40% of LNF versus 10% of LTF patients, while gas-bloat syndrome occurred in 30% vs. 0% (p = 0.07 and 0.04, respectively). No serious adverse events were observed.

LTF provided equivalent reflux control, superior motility preservation, and fewer early obstructive symptoms compared with LNF. LTF should be considered the preferred anti-reflux procedure, particularly in patients with borderline esophageal motility. Larger multicenter trials with longer follow-up are warranted.