Summary
This report describes our preliminary experience with two surgical laparoscopic fundoplication procedures, the Nissen technique and the Toupet operation, in which the fundal wrap is reduced from 360° to 180–200°. Fourteen patients with symptomatic gastroesophageal reflux disease who were refractory to pharmacologic and medical therapy underwent a laparoscopic Nissen fundoplication; in an additional 14 patients, we performed a laparoscopic Toupet partial fundoplication. Our laparoscopic approach to the two procedures does not differ significantly from the traditional open methods and the effectiveness of the laparoscopic fundoplication procedures appears similar to that of the same conventional techniques. Oral feedings can be resumed on the first postoperative day and patients typically are discharged on the second day after surgery. Operative time for performing the Toupet procedure averaged just approximately 1.6 h and was shorter than that for the Nissen fundoplication, due to the use of a stapler to secure the fundal wrap. Confirming earlier observations, the laparoscopic Toupet 180–200° fundoplication was associated with a lower incidence of postoperative digestive complications, such as dysphagia, than was the laparoscopic Nissen operation. The laparoscopic fundoplication approach offers the advantages of clear visualization, adequate dissection and precise repair, along with the benefits associated with endoscopic surgery: diminished postoperative pain and discomfort, reduced hospitalization, and quicker return to normal activities. Our experience indicates that the Toupet fundoplication may be preferable to the Nissen technique for many patients requiring surgical treatment of their reflux disease.
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References
Bagnato VJ (1992) Laparoscopic Nissen fundoplication. Surg Laparosc Endosc 2: 188–190
Baldi F, Ferrarini F, Longanesi A, Angeloni M, Ragazzini M, Miglioli M, Barbara L (1988) Oesphageal function before, during, and after healing of erosive oesophagitis. Gut 29: 157–160
Baue AE, Belsey RHR (1967) The treatment of sliding hiatus hernia and reflux esophagitis by the Mark IV technique. Surgery 62: 396–406
Boutelier P, Jonsell G (1992) An alternative fundoplicative maneuver for gastroesophageal reflux. Am J Surg 143: 260–264
Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R (1991) Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1: 138–143
DeMeester TR, Johnson LF, Kent AH (1974) Evaluation of current operations for the prevention of gastroesophageal reflux. Ann Surg 180: 511–525
Eckardt VF (1988) Does healing of esophagitis improve esophageal motor function? Dig Dis Sci 33: 161–165
Hetzel DJ, Dent J, Reed WD, Narielvala FM, MacKinnon M, McCarthy JH, Mitchell B, Beveridge BR, Laurence BH, Gibson GG, Grant AK, Shearman DJC, Whitehead R, Buckle PJ (1988) Healing and relapse of severe peptic ulcer esophagitis after treatment with omeprazole. Gastroenterology 95: 903–912
Hinder RA, Filipi CJ (1991) The technique of laparoscopic Nissen fundoplication. Surg Laparosc Endosc 2: 265–272
Jamieson GG, Duranceau A, Deschamps C (1988) Surgical treatment of gastroesophageal reflux disease. In: Jamieson GG, Duranceau A (eds) Gastroesophageal reflux. WB Saunders, Philadelphia, p 122–157
Low DE, Mercer CD, James EC, Hill LD (1988) Post Nissen syndrome. Surg Obstet Gynecol 167: 1–5
Lundell L, Abrahamsson H, Ruth M, Sandberg N, Olbe LC (1991) Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360° fundoplication: results of a prospective, randomized, clinical study. World J Surg 15: 115–121
Luostarinen M (1993) Nissen fundoplication for reflux esophagitis. Long-term clinical and endoscopic results in 109 of 127 consecutive patients. Ann Surg 217: 329–337
Martinez de Haro LF, Ortiz A, Parrilla P, Marcilla JAG, Aguayo JL, Morales G (1992) Long-term results of Nissen fundoplication in reflux esophagitis without strictures. Clinical, endoscopic and pH-metric evaluation. Dig Dis Sci 37: 523–527
McKernan JB, Laws HL (in press) Laparoscopic Nissen fundoplication for the treatment of gastroesophageal reflux disease. Am Surg, in press
Negre JB, Markkula HT, Keyrilainen O, Matikainen M (1983) Nissen fundoplication. Results at 10 year follow-up. Am J Surg 146: 635–638
Negre JB (1983) Post-fundoplication symptoms. Do they restrict the success of Nissen fundoplication? Ann Surg 198: 698–700
O'Hanrahan T, Marples M, Bancewicz J (1990) Recurrent reflux and wrap disruption after Nissen fundoplication: detection, incidence and timing. Br J Surg 77: 545–547
Spechler SJ, Veterans Affairs Gastroesophageal Reflux Disease Study Group (1992) Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. New Eng J Med 326: 786–792
Stein HJ, Bremner RM, Jamieson J, DeMeester TR (1992) Effect of Nissen fundoplication on esophageal motor function. Arch Surg 127: 788–791
Thor KBA, Silander T (1989) A long-term randomized prospective trial of the Nissen procedure versus a modified Toupet technique. Ann Surg 210: 719–724
Toupet A (1963) Technique d'oesophago-gastroplastie avec phrenogastropexie appliquee dans la cure radicale des hernies hiatales et comme complement de l'operation d'Heller dans les cardiospasmes. Mem Acad Chir 89: 394
Walker SJ, Holt S, Sanderson CJ, Stoddard CJ (1992) Comparison of Nissen total and Lind partial transabdominal fundoplication in the treatment of gastro-esophageal reflux. Br J Surg 79: 410–414
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McKernan, J.B. Laparoscopic repair of gastroesophageal reflux disease. Surg Endosc 8, 851–856 (1994). https://doi.org/10.1007/BF00843453
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DOI: https://doi.org/10.1007/BF00843453