Preferential performance of Thal fundoplication for gastroesophageal reflux disease: a single institution experience

Abstract

Purpose Nissen fundoplication (NF) is the most commonly used surgical treatment for persistent gastroesophageal reflux disease (GERD). We introduced to the alternative Thal fundoplication (TF) (partial anterior wrapping) in 1998. The purpose of this paper is to review and report on the effectiveness of TF in our department. Methods We retrospectively analyzed cases of 281 patients who underwent TF for GERD at our hospital from 1998 to 2019. Results Average age, 16.3 ± 18.1 years; average body weight, 21.0 ± 16.0 kg; average operative time, 89.1 ± 43.0 min; average volume of bleeding, 11.6 ± 29.2 g; enteral feeding commenced after an average of 3.4 ± 1.3 postoperative days (PODs), and average postoperative full enteral feeding was 6.3 ± 1.4 PODs. Five patients (1.8%) had Clavien–Dindo classification III or higher; average hospital stay duration was 10.3 ± 6.0 days, with symptom recurrence affecting 17 patients (6.1%). Conclusion TF may be an effective and simple treatment for GERD that has few recurrences and avoids complications common to NF, but further studies to compare it with other techniques are needed.

Risk factors for recurrent gastroesophageal reflux disease after Thal fundoplication

“…We reported [ 5 ] that the TF technique may be an effective and simple treatment for GERD, with few recurrences and without the complications common to NF. Furthermore, we believe that TF would be a better technique if the above management could reduce the recurrence of GERD.…”

“…The TF technique was therefore introduced to our surgical department in 1998 because we considered its more physiological approach to be briefer and less complicated than the NF approach. We reported [ 5 ] that the Thal fundoplication (TF) technique may be an effective and simple treatment for GERD, with few recurrences and without the complications common to NF. The advantages of TF include: (1) no surgical interference with the short gastric artery and vein, (2) brief surgery and operative time, (3) few wrap migrations, and (4) low prevalence of gas-bloat syndrome.…”