Results after minimally invasive Toupet fundoplication technique: a narrative review

Abstract

Posterior partial fundoplication (PPF) was developed as an alternative surgical strategy to Nissen fundoplication, in attempt to reduce the rate of side-effects, mainly dysphagia and gas bloat syndrome. Allowing patients to maintain belching ability, this operation could lead to minor gas-related symptoms than total fundoplication. The procedure was first described by Andrè Toupet in 1963 and consisted of a posterior 180° wrap of the gastric fundus through a midline incision. After the first report of anti-reflux surgery performed with the laparoscopic approach, several authors have translated PPF into a minimally invasive approach. A review of literature has been performed to evaluate the results of minimally invasive PPF, focusing on the rate of dysphagia and gastro-esophageal reflux disease (GERD) recurrence. The evidence suggests that laparoscopic PPF is a safe and feasible procedure, and provides similar reflux control compared to laparoscopic total fundoplication, with lower risk of postoperative dysphagia. However, the duration of laparoscopic PPF effect on reflux control over time is questioned, as data on long-term results after laparoscopic Toupet fundoplication are lacking. Further studies are needed to provide long-term functional and clinical results of laparoscopic PPF in order to draw definitive conclusions. Therefore, the controversy regarding the optimal surgical strategy for the management of gastroesophageal reflux continues.