Laparoscopic Toupet versus Nissen fundoplication for the treatment of gastroesophageal reflux disease: Randomized prospective study

Abstract

. ABSTRACT Objective: To compare laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication in terms of postoperative acid reflux control and postoperative complications, especially dysphagia and gas bloat on a short-term basis. Patients and Methods: This prospective randomized study included 50 patients with gastroesophageal reflux disease who presented at Gastrointestinal Surgical Center, Mansoura University, for antireflux surgery from August 2021 to August 2022. Results: The incidence of dysphagia was higher in the Nissen group than in Toupet in early postoperative follow-up (3 months) compared with the Toupet group ( P=0.008 ), but the incidence of dysphagia decreased among the Nissen group during follow-up periods while no incidence of dysphagia in Toupet group ( P=0.077 ). Regarding heartburn score, there was no statistically significance between the two groups Toupet and Nissen ( P=0.200 ) at early follow-up periods. However after 18-month postoperative, Nissen group showed better control of heartburn symptoms when compared to the Toupet group ( P=0.045 ). In the current study, according to quality of life after 1 year and patient satisfaction, there was no significant difference between the two procedures ( P=0.059 ). Conclusion: Nissen fundoplication shows a high incidence of dysphagia and gas bloat symptoms during early postoperative periods when compared with Toupet fundoplication, but this incidence decreases along follow-up periods. On the other hand, Nissen fundoplication shows better acid reflux control all over the follow-up periods