What are the primary types of fundoplication for treating gastroesophageal reflux disease (GERD)?

From the Guidelines

The primary types of fundoplication for treating gastroesophageal reflux disease (GERD) are Nissen fundoplication, Toupet fundoplication, and Dor fundoplication, with Nissen fundoplication being the most common procedure. These procedures can be performed laparoscopically, which offers faster recovery compared to open surgery 1.

Types of Fundoplication

• Nissen fundoplication: a complete 360-degree wrap of the stomach fundus around the lower esophagus, creating a high-pressure zone that prevents reflux but may cause difficulty belching and vomiting.
• Toupet fundoplication: a partial 270-degree posterior wrap that may cause fewer side effects like dysphagia and gas-bloat syndrome while still providing good reflux control.
• Dor fundoplication: a partial 180-degree anterior wrap often performed after Heller myotomy for achalasia but also used for GERD. The choice between these techniques depends on the patient's specific anatomy, severity of GERD, presence of esophageal motility disorders, and surgeon preference 1.

Key Considerations

• Fundoplication works by mechanically reinforcing the lower esophageal sphincter, restoring the angle of His, and reducing hiatal hernia if present, thereby preventing stomach acid from flowing back into the esophagus.
• Laparoscopic approach is recommended for anti-reflux surgery in patients with EA-TEF, and the choice between total or partial fundoplication should be left to the preferences and expertise of surgeons 1.
• The laparoscopic approach is also possible in revisional surgery, but the possibility of a ‘short’ oesophagus must be considered in patients with EA-TEF who failed a previous operation 1.

From the Research

Types of Fundoplication

The primary types of fundoplication for treating gastroesophageal reflux disease (GERD) include:

• Nissen fundoplication: a 360-degree wrap of the fundus around the esophagus 2, 3, 4, 5
• Toupet fundoplication: a 180-200 degree partial wrap of the fundus around the esophagus 2, 3, 4, 6, 5

Comparison of Nissen and Toupet Fundoplication

Studies have compared the outcomes of Nissen and Toupet fundoplication, with results showing:

• Similar effectiveness in controlling reflux symptoms 3, 4, 5
• Lower incidence of postoperative complications, such as dysphagia, with Toupet fundoplication 2, 3, 4, 5
• Shorter operative time for Toupet fundoplication 2
• Lower rate of adverse results, including gas-bloat syndrome and inability to belch, with Toupet fundoplication 4

Indications for Each Type of Fundoplication

The choice of fundoplication type may depend on patient factors, such as:

• Severity of GERD: Nissen fundoplication may be optimal for patients with moderate to severe GERD 5
• Age: Toupet fundoplication may be considered for elderly patients 5
• Esophageal peristalsis: Toupet fundoplication may be considered for patients with significantly reduced esophageal peristalsis 5