Journal of Gastrointestinal Surgery

, Volume 17, Issue 4, pp 822–828 | Cite as

Laparoscopic Total Fundoplication for Gastroesophageal Reflux Disease. How I Do It

  • Marco E. Allaix
  • Fernando A. Herbella
  • Marco G. Patti
How I do it

Abstract

Introduction

A laparoscopic fundoplication is considered today the procedure of choice for the treatment of gastroesophageal reflux disease (GERD).

Discussion

Several eponyms are used in the literature to denote different antireflux operations: Nissen, Nissen-Rossetti, Toupet, Lind, Guarner, Hill, and Dor. We feel that it is more important to focus on the technical elements which make a fundoplication effective and long lasting. The type of fundoplication (total vs. partial) is tailored to the quality of esophageal peristalsis as documented by the preoperative manometry. In the USA, a partial fundoplication is chosen only for patients with very impaired or absent esophageal peristalsis.

Conclusion

This article describes the technique of laparoscopic total fundoplication for GERD. Partial fundoplication is performed following the same technical elements as the total fundoplication. A 240° to 270° wrap rather than a 360° wrap is performed.

Keywords

Gastroesophageal reflux disease Laparoscopic Nissen fundoplication Total fundoplication Partial fundoplication Toupet fundoplication Guarner fundoplication Dor fundoplication 

References

  1. 1.
    Campos GM, Peters JH, DeMeester TR, Oberg S, Crookes PF, Tan S, DeMeester SR, Hagen JA, Bremner CG. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 1999;3:292–300.PubMedCrossRefGoogle Scholar
  2. 2.
    Mainie I, Tutuian R, Agrawal A, Adams D, Castell DO. Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-esophageal reflux for laparoscopic Nissen fundoplication. Br J Surg 2006;93:1483–1487.PubMedCrossRefGoogle Scholar
  3. 3.
    Patti MG, Robinson T, Galvani C, Gorodner MV, Fisichella PM, Way LW. Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. J Am Coll Surg 2004;198:863–869.PubMedCrossRefGoogle Scholar
  4. 4.
    Herbella FA, Tedesco P, Nipomnick I, Fisichella PM, Patti MG. Effect of partial and total laparoscopic fundoplication on esophageal body motility. Surg Endosc 2007;21:285–288.PubMedCrossRefGoogle Scholar
  5. 5.
    Tedesco P, Lobo E, Fisichella PM, Way LW, Patti MG. Laparoscopic fundoplication in elderly patients with gastroesophageal reflux disease. Arch Surg 2006;141:289–292.PubMedCrossRefGoogle Scholar
  6. 6.
    Meneghetti AT, Tedesco P, Galvani C, Gorodner MV, Patti MG. Outcomes after laparoscopic Nissen fundoplication are not influenced by the pattern of reflux. Dis Esophagus 2008;21:165–169.PubMedCrossRefGoogle Scholar
  7. 7.
    Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, Jehaes C. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 2006;20:159–165.PubMedCrossRefGoogle Scholar
  8. 8.
    Broeders JAJL, Mauritz FA, Ahmed Ali U, Draaisma WA, Ruurda JP, Gooszen HG, Smout AJ, Broeders IA, Hazebroek EJ. Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg 2010;97:1318–1330PubMedCrossRefGoogle Scholar
  9. 9.
    Horvath KD, Jobe BA, Herron DM, Swanstrom LL. Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg 1999;3:583–591.PubMedCrossRefGoogle Scholar
  10. 10.
    Oleynikov D, Eubanks TR, Oelschlager BK, Pellegrini CA. Total fundoplication is the operation of choice for patients with gastroesophageal reflux and defective peristalsis. Surg Endosc 2002;16: 909–913.PubMedCrossRefGoogle Scholar
  11. 11.
    Patti MG, Arcerito M, Feo CV, De Pinto M, Tong J, Gantert W, Tyrrell D, Way LW. An analysis of operations for gastroesophageal reflux disease. Identifying the important technical elements. Arch Surg 1998;133:600–606.PubMedCrossRefGoogle Scholar
  12. 12.
    Patterson EJ, Herron DM, Hansen PD, Ramzi N, Standage BA, Swanström LL. Effect of an esophageal bougie on the incidence of dysphagia following Nissen fundoplication: a prospective, blinded, randomized clinical trial. Arch Surg 2000;135:1055–1061.PubMedCrossRefGoogle Scholar
  13. 13.
    Makris KI, Cassera MA, Kastenmeier AS, Dunst CM, Swanström LL. Postoperative dysphagia is not predictive of long-term failure after laparoscopic antireflux surgery. Surg Endosc 2012;26:451–457.PubMedCrossRefGoogle Scholar
  14. 14.
    Patti MG, Gasper WJ, Fisichella PM, Nipomnick I, Palazzo F. Gastroesophageal reflux disease and connective tissue disorders: pathophysiology and implications for treatment. J Gastrointest Surg. 2008;12:1900–1906.PubMedCrossRefGoogle Scholar
  15. 15.
    Horgan S, Pohl D, Bogetti D, Eubanks T, Pellegrini CA. Failed antireflux surgery. What have we learned from reoperations? Arch Surg 1999;134:809–817.PubMedCrossRefGoogle Scholar
  16. 16.
    Watson DI, Jamieson GG, Devitt PG, Matthew G, Britten-Jones RE, Game PA, Williams RS. Changing strategies in the performance of laparoscopic Nissen fundoplication as a result of experience with 230 operations. Surg Endosc 1995;9:961–966.PubMedGoogle Scholar
  17. 17.
    Wu JS, Dunnegan DL, Luttmann DR, Soper NJ. The influence of surgical technique on clinical outcome of laparoscopic Nissen fundoplication. Surg Endosc 1996;10:1164–1170.PubMedCrossRefGoogle Scholar
  18. 18.
    Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD, the SAGES Guidelines Committee. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 2010;24:2647–2669PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Marco E. Allaix
    • 1
  • Fernando A. Herbella
    • 1
  • Marco G. Patti
    • 1
  1. 1.Department of Surgery and Center for Esophageal DiseasesUniversity of Chicago Pritzker School of MedicineChicagoUSA

Personalised recommendations