Nissen or partial posterior fundoplication: which antireflux procedure has a lower rate of side effects?

Abstract

Partial posterior fundoplication is a more physiological antireflux procedure than the Nissen fundoplication, and, therefore, this operation has now become our preferred technique for all GERD patients.

Laparoscopic partial posterior (Toupet) fundoplication improves esophageal bolus propagation on scintigraphy

“…All operations were performed laparoscopically with a fivetrocar technique as previously described [8]. Generous dissection up into the mediastinum, closure of the crura with single nonabsorbable sutures, calibrated with a 36F gastric tube in place was done in all patients.…”

“…Approximately 1 cm of the anterior wall of the esophagus was left unwrapped resulting in a more than 300°w rap, which is different from the originally reported 180°T oupet wrap [12]. Under these circumstances it is possible to obtain a manometrically normal LES not significantly different from the Nissen fundoplication, but with complete relaxation [8,13]. In both procedures nonabsorbable sutures were used (Ethibond 2-0, Ethicon/Johnson & Johnson, Hamburg, Germany).…”

“…Good results have been demonstrated for the laparoscopic partial posterior (Toupet) fundoplication in patients with weak esophageal peristalsis. After this operation the rates of persistent postoperative dysphagia and other side-effects such as inability to belch or gas bloat syndrome are lower than after a 360°fundoplication and it may enable a marked improvement of esophageal peristalsis [8,10]. Whether this manometric and symptomatic improvement of the esophageal function also leads to an improved esophageal emptying on scintigraphy has not been shown yet.…”

“…Patients with impaired esophageal peristalsis have a higher failure rate to medical therapy than patients with normal peristalsis, and therefore, it has been suggested that they are good candidates for antireflux surgery [5].The laparoscopic Nissen fundoplication, which is considered to be the gold standard of antireflux operations [6], may result in an overcorrection of the antireflux barrier, and therefore it may not be an adequate procedure for patients with poor esophageal peristalsis [7]. An increased rate of persistent postoperative dysphagia or stasis esophagitis may develop consequently under these circumstances [8,9]. Good results have been demonstrated for the laparoscopic partial posterior (Toupet) fundoplication in patients with weak esophageal peristalsis.…”

Manometry data support a novel concept of the lower esophageal sphincter system

“…The esophageal paralysis is still present, and the esophagus cannot resume its peristaltic activity. Thus, partial fundoplications have become the standard of care as they treat or prevent GERD symptoms with fewer side effects [23][24][25][26]. One of the reasons for the failure of the classical, total fundoplication in this situation is the circumstance that this procedure seeks to re-construct a ring sphincter or a check valve.…”