Top

Surgical Endoscopy

Published in:

01-02-2012

Laparoscopic Nissen versus Toupet fundoplication: objective and subjective results of a prospective randomized trial

Authors: Oliver O. Koch, Adolf Kaindlstorfer, Stavros A. Antoniou, Kai Uwe Asche, Frank A. Granderath, Rudolph Pointner

Published in: Surgical Endoscopy | Issue 2/2012

Abstract

Background

Although symptom outcomes following laparoscopic fundoplication have been adequately evaluated in the past, comparative subjective data of laparoscopic Nissen and Toupet fundoplications are scarce. Multichannel intraluminal impedance monitoring (MII) has not been used so far for comparison of objective data.

Methods

One hundred patients with documented chronic gastroesophageal reflux disease (GERD) were randomly allocated to either floppy Nissen fundoplication (group I, n = 50) or Toupet fundoplication (group II, n = 50). Gastrointestinal Quality of Life Index (GIQLI), symptom grading, esophageal manometry, and MII data were documented preoperatively and 3 months after surgery. Subjective and objective outcome data were compared to those of healthy individuals.

Results

Symptom intensity was significantly more severe and GIQLI showed impairment in the examined patient population compared to healthy controls. Both procedures resulted in a significant improvement in GIQLI and GERD symptoms (p < 0.01). Dysphagia improved significantly only in group II, while cough, asthma, and distortion of taste improved significantly in both groups. Hoarseness symptoms showed some degree of improvement in both groups but reached statistical significance only in group I. Postoperatively, bowel symptoms partly increased and the ability to belch decreased in both groups (p < 0.05). Comparison of postoperative GIQLI and symptom scores showed no significant difference between the two groups, except for the ability to belch, which was more impaired after Nissen fundoplication. Both procedures resulted in a significant improvement in lower esophageal sphincter (LES) pressure; however, the improvement was greater in group I than in group II. MII data showed more reflux control after Nissen, but the differences between the procedures were not significant.

Conclusions

Both procedures equally improve quality of life and GERD symptoms. Bowel symptoms may increase after both procedures at the 3-month follow-up. Manometry and MII data favor Nissen fundoplication, but dysphagia and the inability to belch are more common compared to Toupet fundoplication.

Granderath FA, Kamolz T, Schweiger UM, Pasiut M, Haas CF, Wykypiel H, Pointner R (2002) Long-term results of laparoscopic antireflux surgery: Surgical outcome and analysis of failure after 500 laparoscopic antireflux procedures. Surg Endosc 16:753–757PubMedCrossRef

Lafullarde T, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG (2001) Laparoscopic Nissen fundoplication: five year result and beyond. Arch Surg 136:180–184PubMedCrossRef

Terry M, Smith CD, Branum GD, Galloway K, Waring JP, Hunter JG (2001) Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia: experience with 1000 consecutive cases. Surg Endosc 15:691–699PubMedCrossRef

Pointner R, Granderath FA (2008) Laparoscopic fundoplication: when, how and what to do if it fails? Eur Surg 40:261–269CrossRef

Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, Grassi GB (2004) Evidence-based appraisal of antireflux fundoplication. Ann Surg 239:325–337PubMedCrossRef

Fein M, Seyfried F (2010) Is there a role for anything other than a Nissen’s operation? J Gastrointest Surg 14(Suppl 1):S67–S74PubMedCrossRef

Broeders JA, Mauritz FA, Ahmed Ali U, Draaisma WA, Ruurda JP, Gooszen HG, Smout AJ, Broeders IA, Hazebroek EJ (2010) Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease. Br J Surg 97(9):1318–1330PubMedCrossRef

Strate U, Emmermann A, Fibbe C, Layer P, Zornig C (2008) Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc 22:21–30PubMedCrossRef

Korolija D, Sauerland S, Wood-Dauphinée S, Abbou CC, Eypasch E (2004) Evaluation of quality of life after laparoscopic surgery. Surg Endosc 18:879–897PubMedCrossRef

10.

Korolija D, Wood-Dauphinée S, Pointner R (2007) Patient-reported outcomes. How important are they? Surg Endosc 21:503–507PubMedCrossRef

11.

Bammer T, Pointner R, Hinder RA (2000) Standard technique for laparoscopic Nissen and Toupet fundoplication. Eur Surg 32:3–6CrossRef

12.

Eypasch E, Williams JI, Wood-Dauphinée S, Ure BM, Schmülling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222PubMedCrossRef

13.

Granderath FA, Kamolz T, Schweiger UM, Pointner R (2002) Long-term follow-up after laparoscopic refundoplication for failed antireflux surgery: quality of life, symptomatic outcome, and patient satisfaction. J Gastrointest Surg 6:812–818PubMedCrossRef

14.

Kamolz T, Bammer T, Wykypiel H Jr, Pasiut M, Pointner R (2000) Quality of life and surgical outcome after laparoscopic Nissen and Toupet fundoplication: one-year follow-up. Endoscopy 32:363–368PubMedCrossRef

15.

Kamolz T, Bammer T, Granderath FA, Pasiut M, Pointner R (2001) Quality of life and surgical outcome after laparoscopic antireflux surgery in the elderly gastroesophageal reflux disease patient. Scand J Gastroenterol 36:116–120PubMedCrossRef

16.

Fuchs KH, Feussner H, Bonavina L, Collard JM, Coosemans W (1997) Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting. Endoscopy 29:298–308PubMedCrossRef

17.

Allen CJ, Parameswaran K, Belda J, Anvari M (2000) Reproducibility, validity, and responsiveness of a disease-specific symptom questionnaire for gastroesophageal reflux. Dis Esophagus 13:265–270PubMedCrossRef

18.

Murray JA, Clouse RE, Conklin JL (2003) Components of the standard oesophageal manometry. Neurogastroenterol Motil 15:591–606PubMedCrossRef

19.

Pandolfino JE, Kahrilas PJ (2005) AGA technical review on the clinical use of esophageal manometry. Gastroenterology 128:209–224PubMedCrossRef

20.

Johnson LF, DeMeester TR (1986) Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol 8(Suppl 1):52–58PubMedCrossRef

21.

Zerbib F, Roman S, Ropert A, Bruley de Varannes S, Pouderoux P, Chaput U, Mion F, Vérin E, Galmiche JP, Sifrim D (2006) Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol 101:1–8CrossRef

22.

Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell DO (2004) Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 99(6):1037–1043PubMedCrossRef

23.

Zerbib F, Bruley des Varannes S, Roman S, Pouderoux P, Artigue F, Chaput U, Mion F, Caillol F, Verin E, Bommelaer G, Ducrotté P, Galmiche JP, Sifrim D (2005) Normal values and day to day variability of 24-h ambulatory oesophageal impedance-pH-monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther 22:1011–1021PubMedCrossRef

24.

Lundell L, Abrahamsson H, Ruth M, Lo Rydberg L, Lönroth H, Olbe L (1996) Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg 83:830–835PubMedCrossRef

25.

Kahrilas P (2008) Gastroesophageal reflux disease. N Engl J Med 359:1700–1707PubMedCrossRef

26.

Guillemot F, Ducrotte P, Bueno L (2005) Prevalence of functional gastrointestinal disorders in a population of subjects consulting for gastrointestinal reflux disease in general practice. Gastroenterol Clin Biol 29:243–246PubMedCrossRef

27.

Sgromo B, Irvine LA, Cuschieri A, Shimi SM (2008) Long-term comparative outcome between laparoscopic total Nissen and Toupet fundoplication: symptomatic relief, patient satisfaction and quality of life. Surg Endosc 22:1048–1053PubMedCrossRef

28.

Klaus A, Hinder RA, DeVault KR, Achem SR (2003) Bowel dysfunction after laparoscopic antireflux surgery: incidence, severity, and clinical course. Am J Med 114(1):6–9PubMedCrossRef

29.

Swanstrom L, Wayne R (1994) Spectrum of gastrointestinal syndromes after laparoscopic fundoplication. Am J Surg 167:538–541PubMedCrossRef

30.

Rieger NA, Jamieson GG, Britten-Jones R, Tew S (1994) Reoperation after failed antireflux surgery. Br J Surg 81:1159–1161PubMedCrossRef

31.

Soper NJ, Dunnegan D (1999) Anatomic fundoplication failure after laparoscopic antireflux surgery. Ann Surg 229:669–677PubMedCrossRef

32.

Carlson MA, Frantzides CT (2001) Complications and results of primary minimally invasive antireflux procedures: a review of 10,735 reported cases. J Am Coll Surg 193:428–439PubMedCrossRef

Title: Laparoscopic Nissen versus Toupet fundoplication: objective and subjective results of a prospective randomized trial
Authors: Oliver O. Koch
Adolf Kaindlstorfer
Stavros A. Antoniou
Kai Uwe Asche
Frank A. Granderath
Rudolph Pointner
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 2/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1889-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic Nissen versus Toupet fundoplication: objective and subjective results of a prospective randomized trial

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2012

Alternative specimen extraction techniques after laparoscopic emergency colectomy in inflammatory bowel disease

Transanal endoscopic microsurgery for T1 rectal cancer: size matters!

Erratum to: Left laparoscopic paraduodenal hernia repair

Repeated transvaginal notes: is it possible?

Less adhesiolysis and hernia repair during completion proctocolectomy after laparoscopic emergency colectomy for ulcerative colitis

Robotic and laparoscopic gastric bypass: are they comparable?