Laparoscopic Nissen versus Toupet fundoplication: assessment of operative outcomes.

BACKGROUND

This study was designed to analyze the outcomes of Nissen fundoplication (NF) versus Toupet fundoplication (TF) in patients undergoing laparoscopic antireflux surgery (LARS).

METHODS

All perioperative data, operative/postoperative complications, and follow-up data were prospectively recorded. All patients were seen on the 2nd month postoperatively and by yearly intervals thereafter. All patients have at least 12-month follow-up. Using SPSS software, groups were compared by t-test and chi-square tests as appropriate.

RESULTS

One thousand consecutive patients underwent primary LARS from May 2004 to August 2009. Six hundred eighty-four patients had NF and 316 had TF fundoplication. The mean follow-up of the NF (51.26 months) group was slightly longer than the TF group (43.53 months) (P=.018). There was no mortality and conversion. Esophageal perforation, jejunal perforation, and pulmonary emboli were the sole three major complications in separate patients. Dysphagia occurred in 15.4% and 9.9% in NF and TF, respectively (P=.001). Corresponding numbers for bloating were 19.6% and 10.8% in NF and TF, respectively (P=.001). Seventeen patients underwent reinterventions such as dilatation and re-do surgery and all 17 were in the NF group (P<.05). All other minor complications were similar except hiccups, which were seen in 30 patients and all were in the NF group (P<.05). Recurrence of reflux was observed in 1.8% and 2.2% of the NF and TF, respectively (P=.620).

CONCLUSION

Both NF and TF are effective procedures in controlling the acid-reflux symptoms. The functional side effects appear more often in the NF group. These side effects can be minimized and reinterventions for severe/prolonged dysphagia can be avoided with TF.