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Surgical Endoscopy

, Volume 24, Issue 12, pp 3080–3085 | Cite as

Population-based trend analysis of laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease

  • U. Zingg
  • L. Rosella
  • U. GullerEmail author
Article
  • 100 Downloads

Abstract

Background

The Nissen and Toupet fundoplications are the most commonly used techniques for surgical treatment of gastroesophageal reflux disease. To date, no population-based trend analysis has been reported examining the choice of procedure and short-term outcomes. This study was designed to analyze trends in the use of Nissen versus Toupet fundoplications, and corresponding short-term outcomes during a 10-year period between 1995 and 2004.

Methods

A trend analysis was performed of 873 patients (Toupet: 254 patients, Nissen: 619 patients) prospectively enrolled in the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery.

Results

The frequency of the performed techniques remained stable during the observation period (p value for trend 0.206). The average postoperative and total length of hospital stay both significantly decreased during the 10-year period from 5.6 to 4.0 days and 6.8 to 4.8 days, respectively (both p values for trend <0.001). The average duration of surgery decreased significantly from 141 minutes to 121 minutes (p value for trend <0.001). There was a trend towards less complications in later years (2000–2004) compared to early years (1995–1999, p = 0.058). Conversion rates were significantly lower in later years compared with early years (p = 0.004).

Conclusions

This is the first trend analysis in the literature reporting clinical outcomes of 873 prospectively enrolled patients undergoing Nissen and Toupet fundoplications during a 10-year period. The proportion of laparoscopic Nissen versus Toupet fundoplications remained stable over time, indicating that literature reports of the advantages of one procedure over the other had minimal influence on surgeons’ choice of technique.

Length of hospital stay, duration of surgery, morbidity, and conversion rate decreased over time, reflecting the learning curve. Clearly, patient outcomes have much improved during the 10-year observation period.

Keywords

Laparoscopic fundoplication Nissen Toupet Trend analysis Outcome 

Notes

Acknowledgment

The authors thank Dr. R. Whitfield, MBBS, FRACS, for revising the manuscript.

Disclosure

This study was supported by grants from Johnson & Johnson and Covidien. Drs. Zingg, Rosella, and Guller have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of SurgeryUniversity Hospital BaselBaselSwitzerland
  2. 2.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  3. 3.Division of Visceral Surgery and Transplantation, Department of Surgery, InselspitalUniversity of BernBernSwitzerland

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