Surgical Endoscopy

, Volume 21, Issue 11, pp 1985–1990 | Cite as

Nissen versus Toupet fundoplication: Results of a randomized and multicenter trial

  • E. Guérin
  • K. Bétroune
  • J. Closset
  • A. Mehdi
  • J. C. Lefèbvre
  • J. J. Houben
  • M. Gelin
  • P. Vaneukem
  • I. El Nakadi



Laparoscopic Toupet fundoplication (TF) is reported to be as effective as Nissen (NF), but to be associated with fewer unfavorable postoperative side-effects. This study evaluates the one- and three-year clinical outcome of 140 randomized patients after a laparoscopic NF or TF.

Patients and methods

Inclusion criteria included patients over 16 years old with complications of gastro-oesophageal reflux disease (GORD) and persistence or recurrence of symptoms after three months of treatment. Subjects with a previous history of gastric surgery or repeated fundoplication, brachy-oesophagus or severe abnormal manometry results were excluded. Seventy-seven NF and 63 TF were performed. The severity of symptoms was assessed before and after the procedure.


One hundred and twenty-one of the 140 patients after one year, and 118 after three years, were evaluated and no statistically significant clinical difference was observed. The level of satisfaction concerning the outcome of the operation remained high after one or three years regardless of the type of fundoplication performed.


Functional complications after NF are not avoided with TF.


Gastro-oesophageal reflux disease (GORD) Laparoscopic Nissen fundoplication Laparoscopic Toupet fundoplication 


  1. 1.
    Cookson R, Flood C, Koo B, Mahon D, Rhodes M (2005) Short-term cost effectiveness and long-term cost analysis comparing laparoscopic Nissen fundoplication with proton-pump inhibitor maintenance for gastro-oesophageal reflux disease. Br J Surg 92(6):700–706PubMedCrossRefGoogle Scholar
  2. 2.
    Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lonroth H, Olbe L (1996) Long-term results of a prospective randomised comparison of total fund wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg 83(6):830–835PubMedCrossRefGoogle Scholar
  3. 3.
    Bessel JR, Finch R, Gotley DC, Smithers BM, Nathanson L, Menzies B (2000) Chronic dysphagia following laparoscopic fundoplication. Br J Surg 87(10):1341–1345CrossRefGoogle Scholar
  4. 4.
    Pelgrims N, Closset J, Sperduto N, Gelin M, Houben JJ (2001) What did the laparoscopic Nissen approach of the gastro-oesophageal reflux really change for the patients 8 years Later? Acta Chirurgica Belgica 2:68–72Google Scholar
  5. 5.
    Zügel N, Jung C, Bruer C, Sommer P, Breitschaft KA (2002) comparison of laparoscopic Toupet versus Nissen fundoplication in gastroesophageal reflux disease. Langenbecks Arch Surg 386(7):494–498PubMedCrossRefGoogle Scholar
  6. 6.
    Bell RC, Hanna P, Mills MR, Bowrey D (1999) Patterns of success and failure with laparoscopic Toupet fundoplication. Surg Endosc 13(12):1189–1194PubMedCrossRefGoogle Scholar
  7. 7.
    Deschamps C, Allen MS, Trastek VF, Johnson JO, Pairolero PC (1998) Early experience and learning curve associated with laparoscopic Nissen fundoplication. J Thorac Cardiovasc Surg 115:281–284PubMedCrossRefGoogle Scholar
  8. 8.
    DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastro- esophageal reflux disease: evaluation of primary repair in 100 consecutive patients. Ann Surg 204:9–20PubMedCrossRefGoogle Scholar
  9. 9.
    Hunter JG, Swanstrom L, Waring JP (1996) Dysphagia after laparoscopic antirefux surgery: the impact of operative technique. Ann Surg 224:51–57PubMedCrossRefGoogle Scholar
  10. 10.
    Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, Jehaes C (2006) Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 20:159–165PubMedCrossRefGoogle Scholar
  11. 11.
    Wu JS, Dunnegan DL, Luttnan DR, Soper NJ (1996) The influence of surgical technique on clinical outcome of laparoscopic Nissen fundoplication. Surg Endosc 10:1164–1170PubMedCrossRefGoogle Scholar
  12. 12.
    Hinder RA, Klinger PJ, Perdikis G, Smith SL (1997) Management of failed antireflux operation. Surg Clin North Am 77(5):1083–1098PubMedCrossRefGoogle Scholar
  13. 13.
    Bretagnol F, Giraudeau B, Mor C, Bourlier P, Gandet O, de Calan L (2002) Laparoscopic fundoplication for gastroesophageal reflux disease: retrospectivestudy of functional results in 243 patients. Ann Chir 127(3):181–187PubMedCrossRefGoogle Scholar
  14. 14.
    Torpy JM, Lynm C (2006) Irritable bowel syndrome. JAMA 295(8):960PubMedCrossRefGoogle Scholar
  15. 15.
    Lundell L (2004) Surgery of gastroesophageal reflux disease: a competitive or complementary procedure? Dig Dis 22(2):161–170PubMedCrossRefGoogle Scholar
  16. 16.
    Watson DI, de Beaux AC (2001) Complications of laparoscopic antirefux surgery. Surg Endosc 15:344–352PubMedCrossRefGoogle Scholar
  17. 17.
    Granderath FA, Schweiger UM, Kamolz T, Pointner R (2005) Dysphagia after laparoscopic antireflux surgery: a problem of hiatal closure more than a problem of the wrap. Surg Endosc 19(11):1439–1446PubMedCrossRefGoogle Scholar
  18. 18.
    Kamolz T, Bammer T, Wykypiel H, Pasiut M, Pointner R (2000) Quality of life and surgical outcome after laparoscopic Nissen and Toupet fundoplication: one year follow-up. Endoscopy 32(5):363–368PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • E. Guérin
    • 1
  • K. Bétroune
    • 2
  • J. Closset
    • 2
  • A. Mehdi
    • 3
  • J. C. Lefèbvre
    • 1
  • J. J. Houben
    • 2
  • M. Gelin
    • 2
  • P. Vaneukem
    • 1
  • I. El Nakadi
    • 2
  1. 1.Department of Digestive SurgeryCentre Hospitalier Universitaire (CHU) de CharleroiCharleroiBelgium
  2. 2.Department of Digestive SurgeryErasme HospitalBrusselsBelgium
  3. 3.Department of Digestive SurgeryCentre Hospitalier Etterbeek Ixelles (CHEI)-HISBrusselsBelgium

Personalised recommendations