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Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility.
Surg Endosc 2008; 22(1):21-30SE

Abstract

OBJECTIVE

To determine the influence of preoperative esophageal motility on clinical and objective outcome of the Toupet or Nissen fundoplication and to evaluate the success rate of these procedures. Nissen fundoplication (360 degrees) is the standard operation in the surgical management of gastroesophageal reflux disease (GERD). In order to avoid postoperative dysphagia it has been proposed to tailor antireflux surgery according to pre-existing esophageal motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and it has been recommended to use the Toupet procedure (270 degrees) in these patients. We performed a randomized trial to evaluate this tailored concept and to compare the two operative techniques concerning reflux control and complication rate (dysphagia).

METHODS

200 patients with GERD were included in a prospective, randomized study. After preoperative examinations (clinical interview, endoscopy, 24-hour pH-metry and esophageal manometry) 100 patients underwent either a laparoscopic Nissen procedure (50 with and 50 without motility disorders), or Toupet (50 with and 50 without motility disorders). Postoperative follow-up after two years included clinical interview, endoscopy, 24-hour pH-metry, and esophageal manometry.

RESULTS

After two years 85% (Nissen) and 85% (Toupet) of patients were satisfied with the operative result. Dysphagia was more frequent following a Nissen fundoplication compared to Toupet (19 vs. 8, p < 0.05) and did not correlate with preoperative motility. Concerning reflux control the Toupet proved to be as good as the Nissen procedure.

CONCLUSION

Tailoring antireflux surgery according to the esophageal motility is not indicated, as motility disorders are not correlated with postoperative dysphagia. The Toupet procedure is the better operation as it has a lower rate of dysphagia and is as good as the Nissen fundoplication in controlling reflux.

Authors+Show Affiliations

Department of General Surgery, Israelitischen Krankenhaus, Hamburg, Germany. ursula.strate@web.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18027055

Citation

Strate, U, et al. "Laparoscopic Fundoplication: Nissen Versus Toupet Two-year Outcome of a Prospective Randomized Study of 200 Patients Regarding Preoperative Esophageal Motility." Surgical Endoscopy, vol. 22, no. 1, 2008, pp. 21-30.
Strate U, Emmermann A, Fibbe C, et al. Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc. 2008;22(1):21-30.
Strate, U., Emmermann, A., Fibbe, C., Layer, P., & Zornig, C. (2008). Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surgical Endoscopy, 22(1), pp. 21-30.
Strate U, et al. Laparoscopic Fundoplication: Nissen Versus Toupet Two-year Outcome of a Prospective Randomized Study of 200 Patients Regarding Preoperative Esophageal Motility. Surg Endosc. 2008;22(1):21-30. PubMed PMID: 18027055.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. AU - Strate,U, AU - Emmermann,A, AU - Fibbe,C, AU - Layer,P, AU - Zornig,C, Y1 - 2007/11/20/ PY - 2006/12/18/received PY - 2007/06/01/accepted PY - 2007/05/08/revised PY - 2007/11/21/pubmed PY - 2008/1/29/medline PY - 2007/11/21/entrez SP - 21 EP - 30 JF - Surgical endoscopy JO - Surg Endosc VL - 22 IS - 1 N2 - OBJECTIVE: To determine the influence of preoperative esophageal motility on clinical and objective outcome of the Toupet or Nissen fundoplication and to evaluate the success rate of these procedures. Nissen fundoplication (360 degrees) is the standard operation in the surgical management of gastroesophageal reflux disease (GERD). In order to avoid postoperative dysphagia it has been proposed to tailor antireflux surgery according to pre-existing esophageal motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and it has been recommended to use the Toupet procedure (270 degrees) in these patients. We performed a randomized trial to evaluate this tailored concept and to compare the two operative techniques concerning reflux control and complication rate (dysphagia). METHODS: 200 patients with GERD were included in a prospective, randomized study. After preoperative examinations (clinical interview, endoscopy, 24-hour pH-metry and esophageal manometry) 100 patients underwent either a laparoscopic Nissen procedure (50 with and 50 without motility disorders), or Toupet (50 with and 50 without motility disorders). Postoperative follow-up after two years included clinical interview, endoscopy, 24-hour pH-metry, and esophageal manometry. RESULTS: After two years 85% (Nissen) and 85% (Toupet) of patients were satisfied with the operative result. Dysphagia was more frequent following a Nissen fundoplication compared to Toupet (19 vs. 8, p < 0.05) and did not correlate with preoperative motility. Concerning reflux control the Toupet proved to be as good as the Nissen procedure. CONCLUSION: Tailoring antireflux surgery according to the esophageal motility is not indicated, as motility disorders are not correlated with postoperative dysphagia. The Toupet procedure is the better operation as it has a lower rate of dysphagia and is as good as the Nissen fundoplication in controlling reflux. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/18027055/Laparoscopic_fundoplication:_Nissen_versus_Toupet_two_year_outcome_of_a_prospective_randomized_study_of_200_patients_regarding_preoperative_esophageal_motility_ L2 - https://dx.doi.org/10.1007/s00464-007-9546-8 DB - PRIME DP - Unbound Medicine ER -