Abstract
Background
Although symptom outcomes following laparoscopic fundoplication have been adequately evaluated in the past, comparative subjective data of laparoscopic Nissen and Toupet fundoplications are scarce. Multichannel intraluminal impedance monitoring (MII) has not been used so far for comparison of objective data.
Methods
One hundred patients with documented chronic gastroesophageal reflux disease (GERD) were randomly allocated to either floppy Nissen fundoplication (group I, n = 50) or Toupet fundoplication (group II, n = 50). Gastrointestinal Quality of Life Index (GIQLI), symptom grading, esophageal manometry, and MII data were documented preoperatively and 3 months after surgery. Subjective and objective outcome data were compared to those of healthy individuals.
Results
Symptom intensity was significantly more severe and GIQLI showed impairment in the examined patient population compared to healthy controls. Both procedures resulted in a significant improvement in GIQLI and GERD symptoms (p < 0.01). Dysphagia improved significantly only in group II, while cough, asthma, and distortion of taste improved significantly in both groups. Hoarseness symptoms showed some degree of improvement in both groups but reached statistical significance only in group I. Postoperatively, bowel symptoms partly increased and the ability to belch decreased in both groups (p < 0.05). Comparison of postoperative GIQLI and symptom scores showed no significant difference between the two groups, except for the ability to belch, which was more impaired after Nissen fundoplication. Both procedures resulted in a significant improvement in lower esophageal sphincter (LES) pressure; however, the improvement was greater in group I than in group II. MII data showed more reflux control after Nissen, but the differences between the procedures were not significant.
Conclusions
Both procedures equally improve quality of life and GERD symptoms. Bowel symptoms may increase after both procedures at the 3-month follow-up. Manometry and MII data favor Nissen fundoplication, but dysphagia and the inability to belch are more common compared to Toupet fundoplication.
Similar content being viewed by others
References
Granderath FA, Kamolz T, Schweiger UM, Pasiut M, Haas CF, Wykypiel H, Pointner R (2002) Long-term results of laparoscopic antireflux surgery: Surgical outcome and analysis of failure after 500 laparoscopic antireflux procedures. Surg Endosc 16:753–757
Lafullarde T, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG (2001) Laparoscopic Nissen fundoplication: five year result and beyond. Arch Surg 136:180–184
Terry M, Smith CD, Branum GD, Galloway K, Waring JP, Hunter JG (2001) Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia: experience with 1000 consecutive cases. Surg Endosc 15:691–699
Pointner R, Granderath FA (2008) Laparoscopic fundoplication: when, how and what to do if it fails? Eur Surg 40:261–269
Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, Grassi GB (2004) Evidence-based appraisal of antireflux fundoplication. Ann Surg 239:325–337
Fein M, Seyfried F (2010) Is there a role for anything other than a Nissen’s operation? J Gastrointest Surg 14(Suppl 1):S67–S74
Broeders JA, Mauritz FA, Ahmed Ali U, Draaisma WA, Ruurda JP, Gooszen HG, Smout AJ, Broeders IA, Hazebroek EJ (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
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
Korolija D, Sauerland S, Wood-Dauphinée S, Abbou CC, Eypasch E (2004) Evaluation of quality of life after laparoscopic surgery. Surg Endosc 18:879–897
Korolija D, Wood-Dauphinée S, Pointner R (2007) Patient-reported outcomes. How important are they? Surg Endosc 21:503–507
Bammer T, Pointner R, Hinder RA (2000) Standard technique for laparoscopic Nissen and Toupet fundoplication. Eur Surg 32:3–6
Eypasch E, Williams JI, Wood-Dauphinée S, Ure BM, Schmülling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222
Granderath FA, Kamolz T, Schweiger UM, Pointner R (2002) Long-term follow-up after laparoscopic refundoplication for failed antireflux surgery: quality of life, symptomatic outcome, and patient satisfaction. J Gastrointest Surg 6:812–818
Kamolz T, Bammer T, Wykypiel H Jr, Pasiut M, Pointner R (2000) Quality of life and surgical outcome after laparoscopic Nissen and Toupet fundoplication: one-year follow-up. Endoscopy 32:363–368
Kamolz T, Bammer T, Granderath FA, Pasiut M, Pointner R (2001) Quality of life and surgical outcome after laparoscopic antireflux surgery in the elderly gastroesophageal reflux disease patient. Scand J Gastroenterol 36:116–120
Fuchs KH, Feussner H, Bonavina L, Collard JM, Coosemans W (1997) Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting. Endoscopy 29:298–308
Allen CJ, Parameswaran K, Belda J, Anvari M (2000) Reproducibility, validity, and responsiveness of a disease-specific symptom questionnaire for gastroesophageal reflux. Dis Esophagus 13:265–270
Murray JA, Clouse RE, Conklin JL (2003) Components of the standard oesophageal manometry. Neurogastroenterol Motil 15:591–606
Pandolfino JE, Kahrilas PJ (2005) AGA technical review on the clinical use of esophageal manometry. Gastroenterology 128:209–224
Johnson LF, DeMeester TR (1986) Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol 8(Suppl 1):52–58
Zerbib F, Roman S, Ropert A, Bruley de Varannes S, Pouderoux P, Chaput U, Mion F, Vérin E, Galmiche JP, Sifrim D (2006) Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol 101:1–8
Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell DO (2004) Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 99(6):1037–1043
Zerbib F, Bruley des Varannes S, Roman S, Pouderoux P, Artigue F, Chaput U, Mion F, Caillol F, Verin E, Bommelaer G, Ducrotté P, Galmiche JP, Sifrim D (2005) Normal values and day to day variability of 24-h ambulatory oesophageal impedance-pH-monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther 22:1011–1021
Lundell L, Abrahamsson H, Ruth M, Lo 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
Kahrilas P (2008) Gastroesophageal reflux disease. N Engl J Med 359:1700–1707
Guillemot F, Ducrotte P, Bueno L (2005) Prevalence of functional gastrointestinal disorders in a population of subjects consulting for gastrointestinal reflux disease in general practice. Gastroenterol Clin Biol 29:243–246
Sgromo B, Irvine LA, Cuschieri A, Shimi SM (2008) Long-term comparative outcome between laparoscopic total Nissen and Toupet fundoplication: symptomatic relief, patient satisfaction and quality of life. Surg Endosc 22:1048–1053
Klaus A, Hinder RA, DeVault KR, Achem SR (2003) Bowel dysfunction after laparoscopic antireflux surgery: incidence, severity, and clinical course. Am J Med 114(1):6–9
Swanstrom L, Wayne R (1994) Spectrum of gastrointestinal syndromes after laparoscopic fundoplication. Am J Surg 167:538–541
Rieger NA, Jamieson GG, Britten-Jones R, Tew S (1994) Reoperation after failed antireflux surgery. Br J Surg 81:1159–1161
Soper NJ, Dunnegan D (1999) Anatomic fundoplication failure after laparoscopic antireflux surgery. Ann Surg 229:669–677
Carlson MA, Frantzides CT (2001) Complications and results of primary minimally invasive antireflux procedures: a review of 10,735 reported cases. J Am Coll Surg 193:428–439
Disclosure
Oliver Owen Koch, Adolf Kaindlstorfer, Stavros A. Antoniou, Kai Uwe Asche, Frank Alexander Granderath, and Rudolph Pointner have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Koch, O.O., Kaindlstorfer, A., Antoniou, S.A. et al. Laparoscopic Nissen versus Toupet fundoplication: objective and subjective results of a prospective randomized trial. Surg Endosc 26, 413–422 (2012). https://doi.org/10.1007/s00464-011-1889-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1889-5