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Influence of wrap length on the effectiveness of Nissen and Toupet fundoplication: a prospective randomized study

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Abstract

Background

Incontinence or hypercontinence of the fundic wrap depends primarily on the length of the valve or the type of procedure. Much less attention has been paid to the fundic wrap length. This study aimed to compare the effectiveness of two different wrap lengths among the patients undergoing partial or total fundoplication.

Methods

For this study, 153 patients were randomized to either Nissen (1.5- or 3-cm wrap) or Toupet (1.5- or 3-cm wrap) laparoscopic fundoplication. The groups were compared according to intensity of dysphagia, esophageal manometry data, ambulatory 24-h pH monitoring data, postoperative esophagitis rate, and overall treatment failure rate.

Results

In all the groups, the tone of the lower esophageal sphincter was significantly increased and the DeMeester score significantly decreased, reaching normal levels. At 6 months after surgery, the Toupet 1.5-cm group had significantly more cases of esophagitis than the 3-cm wrap group (24.2% vs 3.3%; p < 0.05). At 12 months after surgery, only one patient in the Nissen 3-cm group had moderate to severe dysphagia. In all cases, failures were associated with persistent erosive esophagitis. At the 12-month follow-up assessment, treatment failures were significantly more common in Toupet 1.5-cm group than in the Toupet 3-cm group (17.5% vs 2.7%; p < 0.05). However, such differences were not observed in the Nissen groups (7.8% for 1.5 cm and 15.6% for 3 cm; p > 0.05).

Conclusions

Evaluation of the treatment results suggests that the wrap length is important in partial Toupet fundoplication to avoid treatment failures. The 3-cm wrap is superior to the 1.5-cm wrap in cases of partial posterior Toupet fundoplication. The influence of wrap length on treatment failure remains unconfirmed for the Nissen procedure.

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Authors and Affiliations

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

    Antanas Mickevičius

  2. Surgery Department, Kaunas University of Medicine, Eiveniu 2, Kaunas, Lithuania

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

  3. Gastroenterology Department, Kaunas University of Medicine, Eiveniu 2, Kaunas, Lithuania

    Laimas Jonaitis & Limas Kupčinskas

Authors
  1. Antanas Mickevičius
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  2. Žilvinas Endzinas
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  3. Mindaugas Kiudelis
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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 fundoplication: a prospective randomized study. Surg Endosc 22, 2269–2276 (2008). https://doi.org/10.1007/s00464-008-9852-9

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  • DOI: https://doi.org/10.1007/s00464-008-9852-9

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