Heartburn is more likely to recur after Toupet fundoplication than Nissen fundoplication

Toupet (270 degrees) fundoplication is commonly recommended for patients wi th gastroesophageal reflux (GER) and esophageal dysmotility. However, Toupe t fundoplication may be less effective at protecting against reflux than Ni ssen (360 degrees) fundoplication, We therefore compared the effectiveness and durability of both types of fundoplication as a function of preoperativ e esophageal motility. From January 1992 through January 1998, 669 patients with GER underwent laparoscopic fundoplication (78 Toupet, 591 Nissen). Pa tients scored heartburn, regurgitation, and dysphagia preoperatively, and a t 6 weeks and 1 year postoperatively, using a 0 ("none") to 3 ("severe") sc ale. We compared symptom scores (Wilcoxon rank sum test) and redo fundoplic ation rates (Fisher exact test) in Toupet and Nissen patients. We also perf ormed subgroup analyses on 81 patients with impaired esophageal motility (m ean peristaltic amplitude, <30 mm Hg or peristalsis <70% of wet swallows) a nd 588 patients with normal esophageal motility. Toupet and Nissen patients reported similar preoperative heartburn, regurgitation, and dysphagia. At 6 weeks after operation, heartburn and regurgitation were similarly improve d in both groups, but dysphagia was more prevalent among Nissen patients. A fter 1 year, heartburn and regurgitation were re-emerging in Toupet patient s, and dysphagia was again similar between groups. Patients with impaired m otility who have Nissen fundoplication are no more likely to suffer persist ent dysphagia than their counterparts who have Toupet fundoplication. In ad dition, patients with normal motility are more likely to develop symptom re currence after Toupet fundoplication than Nissen fundoplication, with no di stinction in dysphagia rates. We conclude that since Toupet patients suffer more heartburn recurrence than Nissen patients, with similar dysphagia, se lective use of Toupet fundoplication requires further study.