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Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial

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Abstract

Background

A prospective, randomized trial was performed to evaluate the long-term outcome and patient satisfaction of laparoscopic complete 360° fundoplication compared with partial posterior 270° fundoplication. Partial fundoplication is purported to have fewer side effects with a higher failure rate in controlling gastroesophageal reflux disease (GERD), while complete fundoplication is thought to result in more dysphagia and gas-related symptoms.

Methods

Patients were randomized to either laparoscopic Nissen (LN) or laparoscopic Toupet (LT) fundoplication. Esophageal manometry, 24-h pH studies, a detailed questionnaire, and a visual analog symptom (VAS) score were completed before and after surgery. A final global outcome questionnaire was performed. Failure was defined as recurrent GERD requiring revision surgery, maintenance proton pump inhibitor (PPI) therapy, or surgery for postoperative dysphagia.

Results

One hundred patients were randomized to LN (50) or LT (50). There were no differences between LN and LT with respect to postoperative symptoms and physiological variables except a higher wrap pressure in the LN group (15.2 vs. 12.0 mmHg). Dysmotility improved in 8/14 (57%) and 6/11 (54%) patients in the LN group and the LT group, respectively, after surgery. There was no correlation between dysmotility and dysphagia both pre- and post surgery in the two groups. Recurrent symptoms of GERD occurred in 8/47 (17.0%) and 8/48 (16.6%) in the LN group and the LT group, respectively. Outcome of patients with dysmotility was similar to those with normal motility in both groups. At final follow-up (59.76 ± 24.23 months), in the LN group, 33/37 (89.1%) would recommend surgery to others, 32/37 (86.4%) would have repeat surgery, and 34/37 (91.8%) felt they were better off than before surgery. The corresponding numbers for the LT group (follow-up = 55.18 ± 25.97 months) were 35/36 (97.2%), 30/36 (83.3%), and 33/36 (91.6%).

Conclusion

LN and LT are equally effective in restoring the lower esophageal sphincter function and provide similar long-term control of GERD with no difference in dysphagia. Esophageal dysmotility had no influence on the outcome of either operation.

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References

  1. SAGES (1998) Guidelines for surgical treatment of gastroesophageal reflux disease (GERD). Surg Endosc 12:186–188

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. DeMeester TR, Johnson LF, Kent AH (1974) Evaluation of current operations for the prevention of gastrosophageal reflux. Ann Surg 180:511–525

    Article  CAS  PubMed  Google Scholar 

  4. Little AG (1992) Mechanism of action of antireflux surgery: theory and fact. World J Surg 16:320–325

    Article  CAS  PubMed  Google Scholar 

  5. Collard JM, de Gheldere CA, De Kock M, Otte JB, Kestens PJ (1994) Laparoscopic antireflux surgery. What is real progress? Ann Surg 220:146–154

    Article  CAS  PubMed  Google Scholar 

  6. Peters JH, Heimbucher J, Kauer WK, Incarbone R, Bremner CG, DeMeester TR (1995) Clinical and physiologic comparison of laparoscopic and open Nissen fundoplication. J Am Coll Surg 180:385–393

    CAS  PubMed  Google Scholar 

  7. Booth MI, Stratford J, Jones L, Dehn TC (2008) Randomized clinical trial of laparoscopic total (Nissen) versus posterior partial (Toupet) fundoplication for gastro-oesophageal reflux disease based on preoperative oesophageal manometry. Br J Surg 95:57–63

    Article  CAS  PubMed  Google Scholar 

  8. Horvath KD, Jobe BA, Herron DM, Swanstrom LL (1999) Laparoscopic Toupet fundoplication is an inadequate procedure for patients with severe reflux disease. J Gastrointest Surg 3:583–591

    Article  CAS  PubMed  Google Scholar 

  9. Farrell TM, Archer SB, Galloway KD, Branum GD, Smith CD, Hunter JG (2000) Heartburn is more likely to recur after Toupet fundoplication than Nissen fundoplication. Am Surg 66:229–236

    CAS  PubMed  Google Scholar 

  10. Fernando HC, Luketich JD, Christie NA, Ikramuddin S, Schauer PR (2002) Outcomes of laparoscopic Toupet compared to Nissen fundoplication. Surg Endosc 16:905–908

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  12. 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

    Article  CAS  PubMed  Google Scholar 

  13. 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 225:647–654

    Article  CAS  PubMed  Google Scholar 

  14. Fibbe C, Layer P, Keller J, Strate U, Emmermann A, Zornig C (2001) Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical and manometric study. Gastroenterology 121:5–14

    Article  CAS  PubMed  Google Scholar 

  15. 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 22:21–30

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  18. Watson DI, Jamieson GG, Pike GK, Davies N, Richardson M, Devitt PG (1999) Prospective randomised double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg 86:123–130

    Article  CAS  PubMed  Google Scholar 

  19. Baigrie RJ, Cullis SNR, Ndhluni AJ (2005) Randomized double-blind trial of laparoscopic Nissen fundoplication versus anterior partial fundoplication. Br J Surg 92:819–823

    Article  CAS  PubMed  Google Scholar 

  20. Ludemann R, Watson DI, Jamieson GG, Game PA, Devitt PG (2005) Five year follow-up of a randomised clinical trial of laparoscopic total versus anterior 180 degree fundoplication. Br J Surg 92:240–243

    Article  CAS  PubMed  Google Scholar 

  21. Watson DI, Jamieson G, Lally C, Archer S, Bessell JR, Booth M, Cade R, Cullingford G, Devitt PG, Fletcher DR, Hurley J, Kiroff G, Martin CJ, Martin IJ, Nathanson LK, Windsor JA, International Society for Diseases of the Esophagus–Australasian Section (2004) Multicentre, prospective, double blind, randomised trial of laparoscopic Nissen vs anterior 90 degree partial fundoplication. Arch Surg 139:1160–1167

    Article  PubMed  Google Scholar 

  22. Spence GM, Watson DI, Jamieson G, Lally CJ, Devitt PG (2006) Single centre prospective randomised trial of laparoscopic Nissen versus anterior 90 degrees fundoplication. J Gastrointest Surg 10:698–705

    Article  PubMed  Google Scholar 

  23. Guérin E, Bétroune K, Closset J, Mehdi A, Lefèbvre JC, Houben JJ, Gelin M, Vaneukem P, El Nakadi I (2007) Nissen versus Toupet fundoplication: results of a randomized and multicenter trial. Surg Endosc 21:1985–1990

    Article  PubMed  Google Scholar 

  24. Engström C, Lönroth H, Mardani J, Lundell L (2007) An anterior or posterior approach to partial fundoplication? Long-term results of a randomized trial. World J Surg 31:1221–1225

    Article  PubMed  Google Scholar 

  25. Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A (1986) Esophageal peristaltic dysfunction in peptic oesophagitis. Gastroenterology 91:897–904

    CAS  PubMed  Google Scholar 

  26. Rydberg L, Ruth M, Lundell L (1999) Mechanism of action of antireflux procedures. Br J Surg 86:405–410

    Article  CAS  PubMed  Google Scholar 

  27. Zaninotto G, Portale G, Costantini M, Rizzetto C, Guirroli E, Ceolin M, Salvador R, Rampado S, Prandin O, Ruol A, Ancona E (2007) Long-term results (6–10 years) of laparoscopic fundoplication. J Gastrointest Surg 11:1138–1145

    Article  PubMed  Google Scholar 

  28. Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lönroth 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 83:830–835

    Article  CAS  PubMed  Google Scholar 

  29. Pessaux P, Arnaud JP, Delattre JF, Meyer C, Baulieux J, Mosnier H (2005) Laparoscopic antireflux surgery. Five-year results and beyond in 1340 patients. Arch Surg 140:946–951

    Article  PubMed  Google Scholar 

  30. Beckingham IJ, Cariem AK, Bornman PC, Callanan MD, Louw JA (1998) Oesophageal dysmotility is not associated with poor outcome after laparoscopic Nissen fundoplication. Br J Surg 85:1290–1293

    Article  CAS  PubMed  Google Scholar 

  31. Baigrie RJ, Watson DI, Myers JC, Jamieson GG (1997) Outcome of laparoscopic Nissen fundoplication in patients with disordered preoperative peristalsis. Gut 40:381–385

    CAS  PubMed  Google Scholar 

  32. Rydberg L, Ruth M, Abrahamsson H, Lundell L (1999) Tailoring antiresflux surgery: a randomized clinical trial. World J Surg 23:612–618

    Article  CAS  PubMed  Google Scholar 

  33. Kauer WK, Peters JH, DeMeester TR, Heimbucher J, Ireland AP, Bremner CG (1995) A tailored approach to antireflux surgery. J Cardiovasc Thorac Surg 110:141–146

    Article  CAS  Google Scholar 

  34. Lund RJ, Wetcher GJ, Raiser F, Glaser K, Perdikis G, Gadenstätter M, Katada N, Filipi CJ, Hinder RA (1997) Laparoscopic fundoplication for gastroesophageal reflux disease with poor esophageal motility. J Gastrointest Surg 4:301–308

    Article  Google Scholar 

  35. Chrysos E, Tzortzinis A, Tsiaoussis J, Athanasakis H, Vasssilakis J, Xynos E (2001) Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for laparoscopic fundoplication. Am J Surg 182:215–221

    Article  CAS  PubMed  Google Scholar 

  36. Thompson SK, Jamieson GG, Myers CM, Chin K, Watson DI, Devitt PG (2007) Recurrent heartburn after laparoscopic fundoplication is not always recurrent reflux. J Gastrointest Surg 11:642–647

    Article  PubMed  Google Scholar 

  37. Thompson SK, Cai W, Jamieson GG, Zhang AY, Myers JC, Parr ZE, Watson DI, Perrson J, Holtmann G, Devitt PG (2009) Recurrent symptoms after fundoplication with a negative pH study—recurrent reflux or functional heartburn. J Gastrointest Surg 13:54–60

    Article  PubMed  Google Scholar 

  38. Luostarinen MES, Isolauri JO (1999) Randomized trial to study the effect of fundic mobilization on long-term results of Nissen fundoplication. Br J Surg 86:614–618

    Article  CAS  PubMed  Google Scholar 

  39. 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 5-year follow-up. Ann Surg 2:165–170

    Article  Google Scholar 

  40. 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 1:38–42

    Article  Google Scholar 

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Acknowledgments

The authors thank and acknowledge the help of Dr. A. K. Cariem (help with blinded data collection), Dr. R. J. Baigrie (surgery), Dr. J. F. Botha and Mrs. H. Essel (randomization). Their valuable contributions assisted with successful completion of the trial.

Disclosures

Drs. Shaw, Bornman, Beckingham, and Mrs. M. Callanan have no conflicts of interest or financial ties to disclose relating to this study. Dr. Metz has received grant support and/or consultant fees from Astra Zeneca, Takeda Pharmaceuticals, Wyeth, Nycomed, and Santarus. He currently has no active grants with any PPI manufacturers.

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Authors and Affiliations

  1. Department of Surgery, J45 OMB, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa

    John M. Shaw & Philippus C. Bornman

  2. Surgical Gastroenterology Unit, Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa

    John M. Shaw, Philippus C. Bornman & Marie D. Callanan

  3. Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK

    Ian J. Beckingham

  4. Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, PA, 92103, USA

    David C. Metz

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  1. John M. Shaw
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Correspondence to John M. Shaw.

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Shaw, J.M., Bornman, P.C., Callanan, M.D. et al. Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial. Surg Endosc 24, 924–932 (2010). https://doi.org/10.1007/s00464-009-0700-3

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