RESULTS AND COMPLICATIONS OF TOUPET PARTIAL POSTERIOR WRAP - 10 YEARSEXPERIENCE

A 270 degrees posterior wrap, described by Toupet, was performed in 11 2 patients with medically refractory gastroesophageal reflux (GER) ove r a 10-year period. The mean age was 39 months (range, 2 months to 19 years). Thirty percent of the patients were neurologically impaired (N I). The approximation of the crura, the posterior fixation of the wrap , and the posterior partial fundoplication were performed with nonabso rbable sutures, over a bougie. Thirty percent of the NI and 15% of the neurologically normal (NN) children underwent a gastrostomy. Early po stoperative complications were found in 24% of NI and 18% of NN childr en; these were treated medically, except for two bowel obstructions. E ight patients died for reasons unrelated to surgery, and nine were los t to follow-up. The mean follow-up period for the 95 remaining patient s was 3.5 years for NI and 4.9 years for NN children. The evaluation s howed that 6 patients had tempo rary dysphagia and two had food impact ion. Nine wrap herniations (10%) were found; three of them without sym ptoms were noted by routine upper gastrointestinal series and received no treatment. Six wrap herniations with recurrent reflux were reopera ted on successfully. With 90% of patients free of symptoms, the result s of the Toupet procedure compare favorably with those of the Nissen f undoplication because of the retained ability to belch or vomit. Copyr ight (C) 1994 by W.B. Saunders Company