Skip to main content
Log in

Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease

  • Original Article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript



Nissen fundoplication is the most popular laparoscopic operation for the management of gastroesophageal reflux disease (GERD). Partial fundoplications seem to be associated with a lower incidence of postoperative dysphagia, and thus a better quality of life for patients. The aim of this study was to compare the long-term outcome in neurologically normal children who underwent laparoscopic Nissen, Toupet, or Thal procedures in three European centers with a large experience in laparoscopic antireflux procedures.


This study retrospectively analyzed the data of 300 consecutive patients with GERD who underwent laparoscopic surgery. The first 100 cases were recorded for each team, with the first team using the Toupet, the second team using the Thal, and the third team using the Nissen procedure. The only exclusion criteria for this study was neurologic impairment. For this reason, 66 neurologically impaired children (52 Thal, 10 Nissen, 4 Toupet) were excluded from the study. This evaluation focuses on the data for the remaining 238 neurologically normal children. The patients varied in age from 5 months to 16 years (median, 58 months). The median weight was 20 kg. All the children underwent a complete preoperative workup, and all had well-documented GERD. The position of the trocars and the dissection phase were similar in all the procedures, as was the posterior approximation of the crura. The short gastric vessels were divided in only six patients (2.5%). The only difference in the surgical procedures was the type of antireflux valve created.


The median duration of surgery was 70 min. There was no mortality and no conversion in this series. A total of 12 (5%) intraoperative complications (5 Nissen, 5 Toupet, 2 Thal) and 13 (5.4%) postoperative complications (3 Toupet, 4 Nissen, 6 Thal) were recorded. Only six (2.5%) redo procedures (2 Thal, 2 Toupet, 2 Nissen) were performed. After a minimum follow-up period of 5 years, all the children were free of symptoms except nine (3.7%), who sometimes still require medication. The incidence of complications and redo surgery for the three procedures analyzed with the Mann–Whitney U test are not statistically significant.


For pediatric patients with GERD, laparoscopic Nissen, Toupet, and Thal antireflux procedures yielded satisfactory results, and none of the approaches led to increased dysphagia. The 5% rate for intraoperative complications seems linked to the learning curve period. The authors consider the three procedures as extremely effective for the treatment of children with GERD, and they believe that the choice of one procedure over the other depends only on the surgeon’s experience. Parental satisfaction with laparoscopic treatment was very high in all the three series.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Coster DD, Bower WH, Wilson VT, Brebrick RT, Richardson GL (1997) Laparoscopic partial fundoplication vs laparoscopic Nissen–Rossetti fundoplication. Surg Endosc 11: 625–631

    Article  PubMed  CAS  Google Scholar 

  2. Crhysos E, Tzortzinis A, Tsiaoussis J, Athanasakis H, Kazakis T (2001) Prospective randomized trial comparing Nissen to Nissen–Rossetti technique for laparoscopic fundoplication. Am J Surg 182: 215–221

    Article  Google Scholar 

  3. Esposito C, Montupet P, Amici G, Desruelle P (2000) Complications of laparoscopic antireflux surgery in childhood. Surg Endosc 14: 622–624

    Article  PubMed  CAS  Google Scholar 

  4. Esposito C, Montupet P, Reinberg O (2001) Laparoscopic surgery for gastroesophageal reflux disease during the first year of life. J Ped Surg 36: 715–717

    Article  CAS  Google Scholar 

  5. Esposito C, Van der Zee DC, Settimi A, Doldo P, Staiano A, Bax NMA (2003) Risks and benefits of surgical management of gastroesophageal reflux in neurologically impaired children. Surg Endosc 17: 708–710

    Article  PubMed  CAS  Google Scholar 

  6. Fernando HC, Luketich JD, Christie NA, Ikramuddin S, Schauer PR (2002) Outcomes of laparoscopic Toupet compared to laparoscopic Nissen fundoplication. Surg Endosc 6: 905–908

    Article  Google Scholar 

  7. Fonkalsrud EW, Aschraft KW, Coran AG, Ellis DG, et al. (1998) Surgical treatment of gastroesophageal reflux in children: a combined hospital study of 7,467 patients. Pediatrics 101: 419–422

    Article  PubMed  CAS  Google Scholar 

  8. Hagedorn C, Lonroth H, Rydberg L, ruth M, Lundell L (2002) Long-term efficacy of total (Nissen–Rossetti) and posterior partial (Toupet) fundoplication: results of a randomized clinical trial. J Gastrointest Surg 6: 540–545

    Article  PubMed  Google Scholar 

  9. Hunter JG, Swanstrom L, Waring JP (1996) Dysphagia after laparoscopic antireflux surgery: the impact of operative technique. Ann Surg 224: 51–57

    Article  PubMed  CAS  Google Scholar 

  10. Kamolz T, Grandherath FA, Bammer T, Wykypiel H Jr, Pointner R (2002) “Floppy” Nissen vs Toupet laparoscopic fundoplication: quality of life assessment in a 5- year follow-up (part two). Endoscopy 34: 917–922

    Article  PubMed  CAS  Google Scholar 

  11. Laws H, Clements R, Swillie C (1997) A randomized, prospective comparison of the Nissen fundoplication versus the Toupet fundoplication for gastroesophageal reflux disease. Ann Surg 225: 647–654

    Article  PubMed  CAS  Google Scholar 

  12. Leggett PL, Bissell CD, Churchman-Winn R, Ahn C (2000) A comparison of laparoscopic Nissen fundoplication and Rossetti’s modification in 239 patients. Surg Endosc 14: 473–477

    Article  PubMed  CAS  Google Scholar 

  13. Ludemann R, Watson Di, Jamieson GG, Game PA, Devitt PG (2005) Five years follow-up of a randomized clinical trial of laparoscopic total versus anterior 180° fundoplication. Br J Surg 92: 240–243

    Article  PubMed  CAS  Google Scholar 

  14. Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lonroth H, Olbe L (1996) Long-term results of a prospective randomized comparison of total fundic wrap (Nissen–Rossetti) or semifundoplication (Toupet) for gastroesophageal reflux. Br J Surg 83: 830–835

    PubMed  CAS  Google Scholar 

  15. Mattioli G, Esposito C, Lima M, Garzi A, Montinaro L, Cobellis G, et al. (2002) Italian multicenter survey on laparoscopic treatment of gastroesophageal reflux disease in children. Surg Endosc 9: 1666–1668

    Article  Google Scholar 

  16. Montupet Ph (2002) Toupet’s procedure. Semin Laparosc Surg 9: 156–160

    Article  Google Scholar 

  17. Ottignon Y, Pelissier EP, Mantion G, Clement C, Birgen C, et al. (1994) Gastroesophageal reflux: comparison of clinical, pH-metric, and manometric results of Nissen’s and Toupet’s procedures. Gastroenterol Clin Biol 18: 920–926

    PubMed  CAS  Google Scholar 

  18. Patti MG, De Pinto M, de Bellis M, Arcerito M, Tong J, et al. (1997) Comparison of laparoscopic total and partial fundoplication for gastroesophageal reflux. J Gastrointest Surg 11: 309–315

    Article  Google Scholar 

  19. Pessaux P, Arnaud JP, Ghavami B, Flament JB, et al. (2000) Laparoscopic antireflux surgery: comparative study of Nissen, Nissen–Rossetti, and Toupet fundoplication. Surg Endosc 11: 1024–1027

    Article  Google Scholar 

  20. Steyaert H, Al Mohaidly M, Lembo MA, Carfagna L, Tursini S, Valla JS (2003) Long-term outcome of laparoscopic Nissen and Toupet fundoplication in normal and neurologically impaired children. Surg Endosc 4: 543–546

    Article  Google Scholar 

  21. Sydorak RM, Albanese CT (2002) Laparoscopic antireflux procedures in children: evaluating the evidence. Semin Laparosc Surg 9: 133–138

    Article  PubMed  Google Scholar 

  22. van der Zee DC, Arends NJT, Bax NMA (1999) The value of 24-h pH study in evaluating the results of laparoscopic antireflux surgery in children. Surg Endosc 13: 918–921

    Article  PubMed  Google Scholar 

  23. van der Zee DC, Bax KN, Ure BM, Besselink MG, Pakvis DF (2002) Long-term results after laparoscopic Thal procedure in children. Semin Laparosc Surg 9: 168–171

    Article  PubMed  Google Scholar 

  24. van der Zee DC, Bax NMA, Ure BM (2000) Laparoscopic refundoplication in children. Surg Endosc 12: 1103–1104

    Google Scholar 

  25. van der Zee DC, Rövekamp MH, Pull ter Gunne AJ, Bax NMA (1994) Surgical treatment for reflux esophagitis: Nissen versus Thal procedure. Pediatr Surg Int 9: 334–337

    Article  Google Scholar 

  26. Zornig C, Strate U, Fibbe C, Emmermann A, Layer P (2002) Nissen vs Toupet laparoscopic fundoplication. Surg Endosc 5: 758–766

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to C. Esposito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Esposito, C., Montupet, P., van Der Zee, D. et al. Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. Surg Endosc 20, 855–858 (2006).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: