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This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Randomized clinical trial of laparoscopic total (Nissen) versus posterior partial (Toupet) fundoplication for gastro‐oesophageal reflux disease based on preoperative oesophageal manometry. BJS 2008; 95: 57-63.

Published: 12th December 2007

Authors: M. I. Booth, J. Stratford, L. Jones, T. C. B. Dehn

Background

Laparoscopic fundoplication is an accepted treatment for symptomatic gastro‐oesophageal reflux disease. The aim of this study was to clarify whether total (Nissen) or partial (Toupet) fundoplication is preferable, and whether preoperative oesophageal manometry should be used to determine the degree of fundoplication performed.

Method

Preoperative oesophageal manometry was used to stratify 127 patients with established gastro‐oesophageal reflux disease into effective (75) and ineffective (52) oesophageal motility groups. Patients in each group were randomized to Nissen (64) or Toupet (63) fundoplication.

Results

No significant differences between the operative groups were seen in heartburn, regurgitation or other reflux‐related symptoms up to 1 year after surgery. Dysphagia of any degree (27 versus 9 per cent; P = 0·018) and chest pain on eating (22 versus 5 per cent; P = 0·018) were more prevalent at 1 year in the Nissen group. There were no differences in postoperative symptoms between the effective and ineffective motility groups. Surgery failed in eight patients on postoperative pH criteria, three in the Nissen group and five in the Toupet group.

Conclusion

Any differences in the symptomatic outcome of laparoscopic Nissen and Toupet fundoplication appear minimal. There is no reason to tailor the degree of fundoplication to preoperative oesophageal manometry. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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