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Laparoscopic total (Nissen) versus posterior (Toupet) fundoplication for gastroesophageal reflux disease: a propensity score-matched comparison of the perioperative and 1-year follow-up outcome

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Abstract

Introduction

The debate continues as to whether laparoscopic total Nissen (LNF) versus partial posterior Toupet fundoplication (LTF) leads to better outcomes in the surgical treatment of axial hiatal hernia with gastroesophageal reflux disease. In the most recent meta-analysis including 13 RCTs with 1564 patients, no significant difference was found between the two procedures in terms of perioperative complications and recurrent reflux rates. Further comparative analyses are urgently needed.

Methods

This retrospective analysis of prospectively recorded data from the Herniamed Registry compared the perioperative and 1-year follow-up outcomes after total Nissen versus partial Toupet fundoplication. Propensity score matching was chosen as the statistical method. Matching was performed for n = 2290 pairs.

Results

No systematic discrepancy was found between the Nissen and Toupet fundoplication for any of the outcome parameters (intraoperative complications LNF 2.10% vs LTF 1.48%, general complications 2.27% vs 2.88%, postoperative complications 1.44% vs 1.18%, complication-related reoperation 1.00% vs 0.91%, recurrence on 1-year follow-up 6.55% vs 5.33%, pain on exertion on 1-year follow-up 12.49% vs 9.52%, pain at rest on 1-year follow-up 10.44 vs 9.52% and pain requiring treatment on 1-year follow-up 9.61% vs 8.17%). Also the postoperative dysphagia rate showed with 5.34% after LNF and with 4.64% after LTF no significant difference.

Conclusion

The findings presented here did not show any significant difference up to 1 year after Nissen or Toupet fundoplication. This is in concordance with the findings of the meta-analyses. However, the perioperative and 1-year follow-up outcomes demonstrate that both operation techniques should be carried out by experienced surgeons.

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Data availability

The data that support the findings of this study are available from the corresponding author (FK) upon reasonable request.

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Authors and Affiliations

  1. Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany

    F. Köckerling & H. Riediger

  2. COPV-Berlin, Kaiser-Wilhelm-Strasse 24-26, 12247, Berlin, Germany

    D. Jacob

  3. StatConsult GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany

    D. Adolf

  4. Pleissental-Hospital, Ronnenburger Str. 106, 08412, Werdau, Germany

    V. Zherdyev

  5. St. Vincenz-Hospitals Paderborn, Academic Teaching Hospital University Göttingen, Am Busdorf 2, 33098, Paderborn, Germany

    H. Scheuerlein

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  1. F. Köckerling
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  2. D. Jacob
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  3. D. Adolf
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  4. V. Zherdyev
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  5. H. Riediger
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  6. H. Scheuerlein
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Correspondence to F. Köckerling.

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Conflict of interest

Dr. Köckerling reports grants to fund Herniamed from Johnson&Johnson, Norderstedt, Karl Storz, Tuttlingen, MenkeMed, Munich, and DB Karlsruhe, as well as personal fees from DB Karlsruhe. All other authors have nothing to disclose.

Ethical approval

Only cases of routine hernia surgery were documented in the Herniamed Registry and all patients have signed a special informed consent declaration agreeing to participate. The Herniamed Registry has ethical approval (BASEC Nr. 2016—00123; 287/2017 BO2; F-2022-111).

Human and animal rights

This article does not contain any study with animals performed by any of the authors.

Informed consent

All patients with routine hernia surgery documented in the Herniamed Registry have signed an informed consent declaration agreeing to participate.

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Köckerling, F., Jacob, D., Adolf, D. et al. Laparoscopic total (Nissen) versus posterior (Toupet) fundoplication for gastroesophageal reflux disease: a propensity score-matched comparison of the perioperative and 1-year follow-up outcome. Hernia (2024). https://doi.org/10.1007/s10029-024-02988-z

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