Short and long-term results of laparoscopic total fundic wrap (Nissen) or semifundoplication (Toupet) for gastroesophageal reflux disease.

Abstract

INTRODUCTION:

Gastroesophageal reflux disease (GERD) is a common upper GIT disorder. The choice of surgical management options is debatable between laparoscopic Nissen fundoplication (LNF) and Toupet fundoplication (LTF) especially in cases with esophageal dysmotility. PATIENTS AND METHODS/AIMS: 102 patients with chronic GERD divided into 2 groups. Group (1): Patients with good peristalsis (n=70) done LNF. Group (2): Patients with poor peristalsis (n=32) patients done LTF to compare the outcome. They were included in this study. They subjected to clinical, radiological and esophageal motility investigations.

RESULTS:

In postoperative period, Recurrent of heartburn, dysphagia and abdominal distension were found in 5.71% , 14.28% and 27.14% post LNF and in 9.37%, 15.62% and 15.62% post LTF respectively. Pre operative LESP was 10.16±5.4 mmHg in LNF & 9.56±3.51 mmHg in LTF group increased to 20.7±7.84 mmHg early after LNF (p<0.0001) & 15.26±6.47 early after LTF (p = 0.0002). Esophageal 24hrs pH metry in early and late post operative showed a significant improvement of % reflux (p < 0.001) in both groups.

CONCLUSION:

Toupet fundoplication became the procedure of choice of cases with esophageal dysmotility due to its ease of application, patient satisfaction, low dysphagia rate and low levels of abdominal distension.

• Authors: N Gad El-Hak, M Mostafa, E Hamdy, M Haleem
• Journal: Hepato-gastroenterology (Hepatogastroenterology) Vol. 61 Issue 135 Pg. 1961-70 (Oct 2014) ISSN: 0172-6390 [Print] Greece
• PMID: 25713896 (Publication Type: Comparative Study, Journal Article)

Topics

• Abdominal Pain (etiology)
• Adult
• Chronic Disease
• Deglutition Disorders (etiology, surgery)
• Esophageal pH Monitoring
• Esophagitis (etiology, surgery)
• Female
• Fundoplication (adverse effects, methods)
• Gastroesophageal Reflux (complications, diagnosis, physiopathology, surgery)
• Heartburn (etiology, surgery)
• Humans
• Laparoscopy (adverse effects, methods)
• Male
• Middle Aged
• Pain, Postoperative (etiology)
• Patient Satisfaction
• Patient Selection
• Peristalsis
• Pressure
• Recurrence
• Time Factors
• Treatment Outcome