CLINICAL AND MANOMETRIC RESULTS OF LAPAROSCOPIC PARTIAL (TOUPET) AND COMPLETE (ROSETTI-NISSEN) FUNDOPLICATION

It is unclear whether a partial or complete gastric fundoplication don e laparoscopically will offer the best control of reflux with the fewe st side effects, Prospective evaluation of laparoscopic Rosetti-Nissen (360) and Toupet (180) fundoplication was performed with assessment o f clinical and manometric data. Methods: Patients with seven gastroeso phageal reflux referred for surgical correction underwent preoperative motility and upper endoscopy. A Rosetti-Nissen or Toupet fundoplicati on was then performed laparoscopically. Short gastrics were not divide d. No bougie was used in the Toupet, which was sutured intracorporeall y. A 2-cm, loose, floppy wrap about a 50-Fr bougie was performed in th e Nissen, Eleven patients underwent Rosetti-Nissen and 11 Toupet fundo plication. Mean ages, duration symptoms, weight, and baseline LES, wer e not different. Preop esophagitis grades were similar, as were Visick Scores and presence of dysphagia. Results: Visick scores at 6 months were better in the Toupet group than the Rosetti-Nissen (P = 0.07). Pe rsistent Dysphagia in four, Gas-Bloat in two, and Odynophagia in one w ithin the Rosetti-Nissen group accounted for the difference, and were not seen in Toupets. LES pressures differed significantly pre and post op (P < 0.001). The change in LES pressure was significantly different between Toupet and Rosetti-Nissen (chart). Seven patients had postop 24-h pH tests; all had no reflux. [GRAPHICS] Three Rosettis have requi red revision to Toupet, with resolution of their symptoms. Conclusions : In patients with severe GERD, laparoscopic Toupet and Rosetti-Nissen control symptoms and esophageal pH similarly. LES pressures are highe r postop in the Rosetti-Nissen. Dysphagia and gas-bloat are more preva lent in the Nissen group. Laparoscopic Toupet fundoplication may be su perior to Rosetti-Nissen in reducing the frequency of side effects fre quently associated with antireflux surgery, yet with equal control of reflux.