Comparison of results from a randomized trial 1 year after laparoscopic Nissen and Toupet fundoplications
- 548 Downloads
The fundoplication of choice for the surgical treatment of gastroesophageal reflux disease (GERD) still is debated. Multichannel intraluminal impedance monitoring (MII) has not been used to compare objective data, and comparative subjective data on laparoscopic Nissen and Toupet fundoplications are scarce.
This study randomly allocated 125 patients with documented chronic GERD to either laparoscopic floppy Nissen fundoplication (LNF; n = 62) or laparoscopic Toupet fundoplication (LTF; n = 63). The Gastrointestinal Quality of Life Index (GIQLI), symptom grading, esophageal manometry, and MII data were documented preoperatively and 1 year after surgery. The pre- and postprocedure data were compared. Statistical significance was set at a p value lower than 0.01 (NCT01321294).
Both procedures resulted in significantly improved GIQLI and GERD symptoms. Preoperative dysphagia improved in both groups, but the improvement reached significance only in the LTF group. The ability to belch was shown to be significantly more decreased after LNF than after LTF. Gas-bloat and “atypical” extraesophageal symptoms also were decreased after surgery (p < 0.01). However, bowel symptoms were virtually unchanged in both groups. Both procedures resulted in significantly improved lower esophageal sphincter pressures. The improvement was greater in the LNF group than in the LTF group (p < 0.01). The DeMeester score and the numbers of total, acid, proximal, upright, and recumbent reflux episodes decreased in both groups after surgery (p < 0.01). No significant difference between the procedures in terms of MII data was found. Six patients (4.8 %) had to undergo reoperation because of intrathoracic slipping of the wrap. All the patients had undergone LNF.
Both procedures proved to be equally effective in improving quality of life and GERD symptoms. However, the reoperation and dysphagia rates were lower and the ability to belch was higher after LTF than after LNF.
KeywordsGERD quality of life Laparoscopic antireflux surgery Nissen Toupet
Oliver O. Koch, Adolf Kaindlstorfer, Stavros A. Antoniou, Ruzica Rosalia Luketina, Klaus Emmanuel, and Rudolph Pointner have no conflicts of interest or financial ties to disclose.
- 2.Fein M, Seyfried F (2009) Is there a role for anything other than a Nissen’s operation? J Gastrointest Surg 14:S67–S74Google Scholar
- 13.Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell DO (2004) Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 99:1037–1043PubMedCrossRefGoogle Scholar
- 14.Zerbib F, Bruley des Varannes S, Roman S, Pouderoux P, Artigue F, Chaput U, Mion F, Caillol F, Verin E, Bommelaer G, Ducrotté P, Galmiche JP, Sifrim D (2005) Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian–French cohort of healthy subjects. Aliment Pharmacol Ther 22:1011–1021PubMedCrossRefGoogle Scholar
- 17.Broeders JA, Bredenoord AJ, Hazebroek EJ, Broeders IA, Gooszen HG, Smout AJ (2011) Effects of antireflux surgery on weakly acidic reflux and belching. Gut 60:435–441. Epub 30 December 2010Google Scholar
- 21.Broeders JA, Mauritz FA, Ahmed Ali U, Draaisma WA, Ruurda JP, Gooszen HG, Smout AJ, Broeders IA, Hazebroek EJ (2010) Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg 97:1318–1330PubMedCrossRefGoogle Scholar