EVALUATION OF LAPAROSCOPIC TOUPET FUNDOPLICATION AS A PRIMARY REPAIR FOR ALL PATIENTS WITH MEDICALLY RESISTANT GASTROESOPHAGEAL REFLUX

Background: This prospective study assesses the outcome results in 100 consecutive patients with gastroesophageal reflux disease (GERD) trea ted with a laparoscopic Toupet fundoplication. Methods: GERD was confi rmed by 24-h pH study and/or esophagogastroduodenoscopy (EGD). Pre-and postoperative symptoms, operative times, and perioperative complicati ons were recorded on standardized data forms. Early follow-up was at 3 months and late follow-up, including 24-h pH, manometry, and EGD was at 22 months. Results: Preoperative symptoms included heartburn (92%), regurgitation (58%), water brash (39%), and dysphagia (39%). Mean ope rative time was 3.2 hours. There were no conversions to celiotomy and there were no mortalities. The perioperative complication rate was 14% ; 6% (5/83) of patients reported heartburn at 3 months and 20% (15/74) at 22 months. Early and late dysphagia was 20% (17/83) and 9% (7/74), respectively: 24-h pH testing was abnormal in 90% of symptomatic pati ents (9/10), 39% of asymptomatic patients (12/31), and 51% overall. Co nclusions: Despite early improvement in reflux symptoms following lapa roscopic Toupet fundoplications, there is a high incidence of recurren t GERD. Symptomatic follow-up underestimates the true incidence of 24- h pH-documented reflux. Based on these results we cannot recommend the laparoscopic Toupet repair for GERD patients with normal esophageal m otility.