Laparoscopic Toupet partial fundoplication as the primary and sole repair for all patients with gastroesophageal reflux disease: 1-year results of a prospective 5-year study

Introduction: A variety of laparoscopic antireflux operations exist for pat ients with gastroesophageal reflux diseases (GERD). Most surgeons operate u sing the concept of "tailored approach", which depends on esophageal motili ty. We have abandoned this concept because of the relatively high incidence of wrap-related complications in patients treated with laparoscopic Nissen fundoplication compared with patients treated with partial fundoplication. It is our policy to perform laparoscopic Toupet partial fundoplication in all patients suffering from GERD, independent of their esophageal motility. Methods: In a prospective trial we have assessed and evaluated our 1-year results of the first 100 consecutive patients treated with Toupet partial f undoplication. All patients underwent esophagogastroscopy and 24-h pH manom etry before operation. One third of patients (n = 34) underwent control man ometry 8 weeks postoperatively. The patients were followed up clinically 1, 2, 6 and 12 months postoperatively. Results: In this study group we achiev ed a healing rate in GERD of 97%. In 3% of patients GERD recurred. The medi an clinical DeMeester score decreased from 4.27 +/- 1.5 points preoperative ly to 0.25 +/- 0.5 points 1 year postoperatively (P < 0.0005). The median f ractional time with pH < 4 decreased from 17.8% +/- 12.5% preoperatively to 0.9% +/- 1.2% 8 weeks postoperatively (P < 0.0005). Because of persistent dysphagia 5% of our patients required postoperative dilatation therapy. The rate of reoperation and mortality was 0%. The total morbidity rate was 18% . In 50% of patients with preoperatively recorded esophageal motility disor der, an improvement of esophageal motility was found postoperatively. Concl usions: Our 1-year results encourage us to continue to perform laparoscopic Toupet partial fundoplication as the primary repair in all GERD patients, independent of their esophageal motility. Laparoscopic Toupet partial fundo plication has proven to be a safe and highly successful therapeutic option in these patients.