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Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study

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Abstract

Background

Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment.

Methods

A total of 153 patients were randomized to Nissen or Toupet 1.5- or 3-cm wrap laparoscopic fundoplication. The primary endpoint—treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up.

Results

At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (P < 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis—32.4 %—was found in Toupet 1.5-cm group.

Conclusions

Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication.

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References

  1. Fuchs KH, Feussner H, Bonavina L, Collard JM, Coosemans W (1997) Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting. The European Study Group for Antireflux Surgery (ESGARS). Endoscopy 29(4):298–308

    Article  PubMed  CAS  Google Scholar 

  2. Society of American Gastrointestinal Endoscopic Surgeons (SAGES) (1998) Guidelines for surgical treatment of gastroesophageal reflux disease (GERD). Surg Endosc 12(2):186–188

    Article  Google Scholar 

  3. Nissen R (1956) Gastropexy as the lone procedure in the surgical repair of hiatus hernia. Am J Surg 92(3):389–392

    Article  PubMed  CAS  Google Scholar 

  4. Toupet A (1963) Technic of esophago-gastroplasty with phrenogastropexy used in radical treatment of hiatal hernias as a supplement to Heller’s operation in cardiospasms. Mem Acad Chir (Paris) 89:384–389

    CAS  Google Scholar 

  5. Dor J, Humbert P, Veal Dor (1962) The role of the modified Nissen procedure in the prevention of reflux following Heller’s extramucosal cardiomyotomy. Mem Acad Chir 88:877–882

    Google Scholar 

  6. Chrysos E, Tsiaoussis J, Zoras OJ, Athanasakis E, Mantides A, Katsamouris A et al (2003) Laparoscopic surgery for gastroesophageal reflux disease patients with impaired esophageal peristalsis: total or partial fundoplication? J Am Coll Surg 197(1):8–15

    Article  PubMed  Google Scholar 

  7. Zornig C, Strate U, Fibbe C, Emmermann A, Layer P (2002) Nissen vs. Toupet laparoscopic fundoplication. Surg Endosc 16(5):758–766

    Article  PubMed  CAS  Google Scholar 

  8. Laws HL, Clements RH, Swillie CM (1997) A randomized, prospective comparison of the Nissen fundoplication versus the Toupet fundoplication for gastroesophageal reflux disease. Ann Surg 225(6):647–653

    Article  PubMed  CAS  Google Scholar 

  9. Walker SJ, Holt S, Sanderson CJ, Stoddard CJ (1992) Comparison of Nissen total and Lind partial transabdominal fundoplication in the treatment of gastro-oesophageal reflux. Br J Surg 79(5):410–414

    Article  PubMed  CAS  Google Scholar 

  10. Thor KB, Silander T (1989) A long-term randomized prospective trial of the Nissen procedure versus a modified Toupet technique. Ann Surg 210(6):719–724

    Article  PubMed  CAS  Google Scholar 

  11. 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 gastro-oesophageal reflux. Br J Surg 83(6):830–835

    Article  PubMed  CAS  Google Scholar 

  12. DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 204(1):9–20

    Article  PubMed  CAS  Google Scholar 

  13. del Pino Porres FJ, Sancho FS, Benages MA, Mora F (2000) Manometric comprobation of esophagogastric junction competence after Nissen fundoplication and its relation to the length of fundic wrap. World J Surg 24(7):870–873

    Article  PubMed  Google Scholar 

  14. Mickevicius A, Endzinas Z, Kiudelis M, Jonaitis L, Kupcinskas L, Maleckas A et al (2008) Influence of wrap length on the effectiveness of Nissen and Toupet fundoplication: a prospective randomized study. Surg Endosc 22(10):2269–2276

    Article  PubMed  Google Scholar 

  15. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP et al (1999) Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 45(2):172–180

    Article  PubMed  CAS  Google Scholar 

  16. Mardani J, Lundell L, Lonroth H, Dalenback J, Engstrom C (2009) Ten-year results of a randomized clinical trial of laparoscopic total fundoplication with or without division of the short gastric vessels. Br J Surg 96(1):61–65

    Article  PubMed  CAS  Google Scholar 

  17. O’Boyle CJ, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG (2002) Division of short gastric vessels at laparoscopic Nissen fundoplication: a prospective double-blind randomized trial with 5-year follow-up. Ann Surg 235(2):165–170

    Article  PubMed  Google Scholar 

  18. Yang H, Watson DI, Lally CJ, Devitt PG, Game PA, Jamieson GG (2008) Randomized trial of division versus nondivision of the short gastric vessels during laparoscopic Nissen fundoplication: 10-year outcomes. Ann Surg 247(1):38–42

    Article  PubMed  Google Scholar 

  19. Strate U, Emmermann A, Fibbe C, Layer P, Zornig C (2008) Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc 22(1):21–30

    Article  PubMed  CAS  Google Scholar 

  20. Broeders JA, Mauritz FA, Ahmed AU, Draaisma WA, Ruurda JP, Gooszen HG et al (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(9):1318–1330

    Article  PubMed  CAS  Google Scholar 

  21. Shan CX, Zhang W, Zheng XM, Jiang DZ, Liu S, Qiu M (2010) Evidence-based appraisal in laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease. World J Gastroenterol 16(24):3063–3071

    Article  PubMed  Google Scholar 

  22. Wykypiel H, Hugl B, Gadenstaetter M, Bonatti H, Bodner J, Wetscher GJ (2008) Laparoscopic partial posterior (Toupet) fundoplication improves esophageal bolus propagation on scintigraphy. Surg Endosc 22(8):1845–1851

    Article  PubMed  CAS  Google Scholar 

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Disclosures

Antanas Mickevičius, Žilvinas Endzinas, Mindaugas Kiudelis, Laimas Jonaitis, Limas Kupčinskas, Juozas Pundzius, and Almantas Maleckas have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Surgery Department, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, Lithuania

    Antanas Mickevičius, Žilvinas Endzinas, Mindaugas Kiudelis, Juozas Pundzius & Almantas Maleckas

  2. Gastroenterology Department, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, Lithuania

    Laimas Jonaitis & Limas Kupčinskas

  3. S. Lozoraicio 32, 50116, Kaunas, Lithuania

    Antanas Mickevičius

Authors
  1. Antanas Mickevičius
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  2. Žilvinas Endzinas
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  3. Mindaugas Kiudelis
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  4. Laimas Jonaitis
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  5. Limas Kupčinskas
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  6. Juozas Pundzius
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  7. Almantas Maleckas
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Correspondence to Antanas Mickevičius.

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Mickevičius, A., Endzinas, Ž., Kiudelis, M. et al. Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study. Surg Endosc 27, 986–991 (2013). https://doi.org/10.1007/s00464-012-2550-7

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  • DOI: https://doi.org/10.1007/s00464-012-2550-7

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