Laparoscopic Toupet Fundoplication as a First Line Surgical Treatment of GERD versus Nissen Fundoplication a Retrospective Comparative Study
Authors: Ibrahim Diab Omar Ayman , Fawzy Ashraf Mohamed , Elserafy Mohamed Ezzat , Nagy Mina Mamdouh 
Published: November 2024

Abstract

Background
Gastroesophageal reflux disease (GERD) is a frequent clinical condition characterized by the reflux of gastric constituents into the esophagus or oropharynx via the lower esophageal sphincter (LES), producing discomfort and/or harm to esophageal tissue serious enough to disturb a patient's life. Acid reflux into the esophagus may cause esophagitis, tracheobronchitis, stricture, Barrett’s esophagus and even esophageal cancer.

Aim of the Work
to evaluate the surgical results of a partial 270 degree wrap (Toupet) versus a total 360 degree wrap (Nissen) in patients with gastroesophageal reflux disease (GERD) in accordance with symptom alleviation, and postoperative complications like dysphagia and gas bloat disorder.

Patients and Methods
This study is a retrospective cohort study. It was conducted at (the General surgery department), Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. The study period Between January 2023 and November 2023.

Results
In this retrospective cohort study comparing Toupet versus Nissen fundoplication in GERD patients, baseline characteristics including age, BMI, and gender distribution were similar between groups (p &gt; 0.05). Prevalence of hypertension and diabetes mellitus did not significantly differ between the two groups (p &gt; 0.05). These findings suggest comparable baseline characteristics and comorbidity distributions among GERD patients undergoing either Toupet or Nissen fundoplication procedures. The study was conducted on patients with no significant differences in UGI endoscopy grades (p = 0.442), reflux severity during GG meal testing (p = 0.540), or LES pressure (p = 0.204) preoperatively. The study found a significant difference in operative time (p = 0.011) but not in hospitalization duration (p = 0.854), indicating shorter operative time for Nissen Fundoplication. No significant differences were observed in dysphagia (p = 0.080), heartburn (p = 0.388), regurgitation (p = 0.247), or gas bloat (p = 0.723), though trends suggested potential variations, requiring larger samples for confirmation.

Conclusion
This retrospective comparative study assessing the outcomes of Toupet and Nissen fundoplication procedures as first-line surgical treatments for GERD revealed several notable findings. While the Nissen procedure demonstrated a shorter operative time compared to the Toupet procedure, both interventions exhibited similar hospitalization durations. Moreover, there were comparable rates of postoperative complications including dysphagia, heartburn, regurgitation, and gas bloat between the two groups, although trends suggesting potential differences were observed in dysphagia and heartburn occurrences. These results suggest that while both procedures are effective in managing GERD, Toupet can be considerd as an effective alternative procedure for patients with GERD with advantage of lower postoperative complications such as dysphagia and gas bloat.