Laparoscopic antireflux surgery: comparative study of Nissen, Nissen-Rossetti, and Toupet fundoplication

Background: The aim of this retrospective study was to compare the results of Nissen, Nissen-Rossetti, and Toupet laparoscopic fundoplication in terms of gastroesophageal reflux disease (GERD). Methods: From 1992 to 1996, 1,470 laparoscopic fundoplications were perform ed using one of three procedures: Nissen (n = 655), Nissen-Rossetti (n = 42 3), and Toupet(n = 392). Preoperative checkup included esophagogastroduoden oscopy in 1,437 patients (97.7%), esophageal manometry in 934 patients (63. 5%), and 24-h pH-metry in 799 patients (54.3%). The results were estimated at 1 month, 3 months, and 2 years. Patients unable to visit the hospital ce nter were contacted by telephone. Results: The three groups were quite similar regarding demographic data suc h as age, gender, preoperative clinical symptoms, and duration of GERD. One death (0.07%) occurred. At 3 months, there were no differences among the t hree groups concerning conversion, morbidity, dysphagia, early reinterventi on, or postoperative length of stay. The length of surgery was more importa nt in the Toupet procedure. In the Nissen group, there were fewer Visick gr ade I patients but more Visick grade III patients. At 2 years, the recurren ce and reintervention rates were similar. The overall residual severe dysph agia rate was 0.35% (n = 5). In the Nissen group, there were fewer Visick g rade I patients but more in Visick grade II patients. There was no differen ce in Visick grade III and IV among the groups. More than 90% of the patien ts were satisfied (Visick I + Visick II), with no significant difference am ong the three groups. Conclusions: The results of this study do not differ significantly from the data reported in the Literature, suggesting such surgical techniques are e ffective and well tolerated, and that both can be properly used in the trea tment of GERD.