Nissen’s vs Toupet fundoplication in management of GERD

Abstract

Abstract

Introduction: Laparoscopic fundoplication is the gold standard treatment for gastroesophageal reflux disease (GERD) refractory to medical management. Although many studies have compared Nissen fundoplication (NF) to Toupet fundoplication (TF), it is unclear which operation provides the best long-term reflux control. Aim: To compare post-operative outcome on quality of life, anatomical failure, symptom relieve & recurrence rate between Nissen’s & Toupet fundoplication in management of GERD. Patients and Methods: Clinical data from Ain-shams university hospitals & Nasser institute for medical research and treatment at the period from January 2018 to September 2018 were used to identify patients who underwent NF or TF, Nissen’s: 10 patients, Toupet: 10 patients. Postoperative QoL was assessed through telephone at 1, 3, and 6 Months post-surgery, using GERD-health related quality of life (GERD-HRQL) and Eckardt Dysphagia scores. Proton pump inhibitor (PPI) use and satisfaction with surgery were also obtained. Results: Our study included 20 patients, 10 TF and 10 NF. Nissen group shows increase post-operative symptoms relieve compared to toupet group. On the other-hand Nissen group shows increase rate of post-operative complications compared to Toupet group according to Dysphagia and gas related symptoms. Short-term satisfaction was equivalent between TF and NF patients 6 Months postoperatively (70.0% versus 80%). Conclusion: Laparoscopic Toupet Fundoplication seems to be as safe and effective as Laparoscopic Nissen Fundoplication, but showed a lower incidence of postoperative dysphagia. while this study sought to characterize post-operative efficacy of two fundoplication procedures, the optimal anti-reflux strategy for patients with GERD still remains inconclusive given the current literature available. Additional multicenter prospective studies with long-term follow-up data are needed.