From the Guidelines
The main difference between a Watson and Dor fundoplication lies in their surgical approach and anatomical positioning, with the Watson fundoplication being a partial posterior wrap and the Dor fundoplication being an anterior partial wrap. The Watson fundoplication is a partial posterior wrap where the fundus of the stomach is wrapped around the posterior aspect of the esophagus, typically covering about 270 degrees of the esophageal circumference. In contrast, a Dor fundoplication is an anterior partial wrap where the fundus is brought forward to cover the anterior portion of the esophagus, usually covering about 180-200 degrees. Both procedures are used to treat gastroesophageal reflux disease (GERD) by reinforcing the lower esophageal sphincter, but they differ in their mechanical approach. The choice between these procedures depends on the patient's specific condition, anatomy, and the surgeon's expertise and preference, as noted in recent clinical practice updates on the management of GERD 1. Some key considerations include the patient's esophageal peristaltic function and the presence of hiatal hernia, which may influence the choice of procedure. For example, patients with known esophageal hypomotility or impaired peristaltic reserve may be better suited for a partial fundoplication, such as the Dor procedure, to minimize the risk of postoperative dysphagia 1. Ultimately, the decision between a Watson and Dor fundoplication should be tailored to the individual patient's needs and circumstances. Key factors to consider include:
- The patient's specific condition and anatomy
- The surgeon's expertise and preference
- The presence of hiatal hernia or other complicating factors
- The potential risks and benefits of each procedure, including the risk of dysphagia and the effectiveness of reflux control.
From the Research
Difference between Watson and Dor Fundoplication Procedures
There are no research papers to assist in answering this question as the provided studies do not mention Watson fundoplication procedures. However, the studies do compare Nissen and Toupet fundoplication procedures.
Nissen and Toupet Fundoplication Procedures
- The Nissen fundoplication is a total (360°) wrap, and is the most commonly performed antireflux operation 2.
- The Toupet fundoplication is a partial (270°) wrap, and is often used as an alternative to the Nissen procedure to lessen the potential for postoperative dysphagia 3, 4.
- Studies have shown that the Toupet procedure is safe and effective in treating the symptoms of gastroesophageal reflux disease (GERD), including patients with severe forms of the disease 3, 5, 6.
- The Toupet procedure has been found to have a lower rate of postoperative dysphagia and gas bloating compared to the Nissen procedure 5, 6.
- However, some studies have reported that the Toupet procedure may have a higher long-term failure rate than the Nissen approach, especially for patients with severe forms of GERD 4.
Dor Fundoplication Procedure
- The Dor fundoplication is an anterior (180°) wrap, and is also used to reduce postoperative dysphagia and gas bloating 2.
- However, there is limited information available on the Dor fundoplication procedure in the provided studies, and no direct comparison with the Watson fundoplication procedure can be made.