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Comparison of results from a randomized trial 1 year after laparoscopic Nissen and Toupet fundoplications

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Abstract

Background

The fundoplication of choice for the surgical treatment of gastroesophageal reflux disease (GERD) still is debated. Multichannel intraluminal impedance monitoring (MII) has not been used to compare objective data, and comparative subjective data on laparoscopic Nissen and Toupet fundoplications are scarce.

Methods

This study randomly allocated 125 patients with documented chronic GERD to either laparoscopic floppy Nissen fundoplication (LNF; n = 62) or laparoscopic Toupet fundoplication (LTF; n = 63). The Gastrointestinal Quality of Life Index (GIQLI), symptom grading, esophageal manometry, and MII data were documented preoperatively and 1 year after surgery. The pre- and postprocedure data were compared. Statistical significance was set at a p value lower than 0.01 (NCT01321294).

Results

Both procedures resulted in significantly improved GIQLI and GERD symptoms. Preoperative dysphagia improved in both groups, but the improvement reached significance only in the LTF group. The ability to belch was shown to be significantly more decreased after LNF than after LTF. Gas-bloat and “atypical” extraesophageal symptoms also were decreased after surgery (p < 0.01). However, bowel symptoms were virtually unchanged in both groups. Both procedures resulted in significantly improved lower esophageal sphincter pressures. The improvement was greater in the LNF group than in the LTF group (p < 0.01). The DeMeester score and the numbers of total, acid, proximal, upright, and recumbent reflux episodes decreased in both groups after surgery (p < 0.01). No significant difference between the procedures in terms of MII data was found. Six patients (4.8 %) had to undergo reoperation because of intrathoracic slip** of the wrap. All the patients had undergone LNF.

Conclusions

Both procedures proved to be equally effective in improving quality of life and GERD symptoms. However, the reoperation and dysphagia rates were lower and the ability to belch was higher after LTF than after LNF.

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Disclosures

Oliver O. Koch, Adolf Kaindlstorfer, Stavros A. Antoniou, Ruzica Rosalia Luketina, Klaus Emmanuel, and Rudolph Pointner have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General Surgery, General Hospital Zell am See, 5700, Zell am See, Austria

    Oliver O. Koch, Adolf Kaindlstorfer, Stavros A. Antoniou & Rudolph Pointner

  2. Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria

    Oliver O. Koch, Ruzica Rosalia Luketina & Klaus Emmanuel

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  1. Oliver O. Koch
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  2. Adolf Kaindlstorfer
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  3. Stavros A. Antoniou
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  4. Ruzica Rosalia Luketina
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  5. Klaus Emmanuel
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  6. Rudolph Pointner
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Correspondence to Oliver O. Koch.

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Koch, O.O., Kaindlstorfer, A., Antoniou, S.A. et al. Comparison of results from a randomized trial 1 year after laparoscopic Nissen and Toupet fundoplications. Surg Endosc 27, 2383–2390 (2013). https://doi.org/10.1007/s00464-013-2803-0

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  • DOI: https://doi.org/10.1007/s00464-013-2803-0

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