The Nissen
fundoplication is not the proper antireflux procedure for patients with poor esophageal peristalsis as it does not strengthen impaired esophageal peristalsis. The aim of this study was to investigate if tailoring of antireflux surgery according to esophageal contractility is an effective treatment of
gastroesophageal reflux disease (
GERD) with a low incidence of postoperative
dysphagia. The Toupet
fundoplication was laparoscopically performed on 32 patients with poor esophageal peristalsis and the Nissen
fundoplication on 17 patients with normal peristalsis. After a median follow-up of 15 months, only 1 of the 49 patients (2.04%) complained of
heartburn. Acute
esophagitis was found in none of them on endoscopy. Of 40 patients tested postoperatively, 2 (5%) underwent pathologic esophageal pH monitoring. Postoperative
dysphagia was found in two patients (4.1%) compared with 25 (51%) preoperatively (p < 0.05). There was a significant reduction of
dysphagia following the Toupet
fundoplication. Both procedures increased the resting pressure of the lower esophageal sphincter (LES) significantly, which was more pronounced following the Nissen
fundoplication. Relaxation of the LES was significantly better following the Toupet than after the Nissen
fundoplication. There was significant improvement of esophageal peristalsis following the Toupet
fundoplication. Tailored antireflux surgery is an effective strategy for treatment of
GERD. The incidence of postoperative
dysphagia is low owing to improvement of impaired esophageal peristalsis following the Toupet
fundoplication. It may be due to the fact that the Toupet
fundoplication causes less esophageal outflow resistance than the Nissen
fundoplication.