Comparative Study of Standard Fundoplication (Nissen and Toupet) vs. Modified Toupet Fundoplication for GERD Repair

Mihael Sok, Boris Greif, Tomaž Štupnik and Matevž Srpčič

Department of Thoracic Surgery, University Medical Centre Ljubljana, Slovenia
Department of Medicine, University of Ljubljana, Slovenia

^*Correspondance to: Mihael Sok 

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Abstract:

Introduction: Failure following anti reflux surgery for GERD is reported from 3% to 30%, predominantly from reflux recurrence. Modified Fundoplication follows the principles of standard Nissen or Toupet Fundoplication. The difference is in the fixation of esophagogastric junction intraabdominally, technically with two retro esophageal Fundo-crural muscle stitches and a retroesophageal fundo- right crus stich. No stitches in the esophagus are used.
Aim: A comparative study of modified fundoplication vs. standard (Toupet or Nissen) fundoplication was carried out. Material and
Methods: Patients with documented gastroesophageal reflux entered a prospective nonrandomized, feasibility study. Patients who underwent a different type of operation were comparable for age, gender, BMI, functional esophageal test before operation, number of hiatal stitches, and hiatal hernia presence at operation and hospitalization time.
Aim: To compare modified Toupet with standard Fundoplication with respect to functional postoperative results.
Results: A total of 70 patients, 42 female and 28 male patients, were operated on laparoscopically for GERD. Standard Fundoplication was carried out in 61 patients and modified Toupet in 9 patients. After 2-5 years of follow up 4(6%) patients from the standard Fundoplication group underwent re operation, among them one for reflux recurrence. No patients from the modified Toupet group needed repeat surgery. In the same postoperative period 37(69%) patients were without PPI from the standard group in comparison to 6(75%) patients from the modified Toupet group.
Conclusion: The modified Toupet Fundoplication is technically simpler to perform, is not inferior to standard Fundoplication and is feasible with promising results. The importance of GEJ fixation to crural muscles and plastics of Gastroesophageal flap valve is discussed.

Keywords:

Gastroesophageal reflux; Antireflux surgery; Reflux recurrence; Modified Fundoplication

Cite the Article:

Sok M, Greif B, Štupnik T, Srpčič M. Comparative Study of Standard Fundoplication (Nissen and Toupet) vs. Modified Toupet Fundoplication for GERD Repair. World J Surg Surgical Res. 2018; 1: 1056.