Objectives: The aim of this prospective study was to evaluate and to compare the results of the circular fundoplication (Nissen) and the posterior hemifundoplication (Toupet) for the treatment of gastro-oesophageal reflux.
Methods: For each of the 71 included patients (Nissen, n:43; Toupet, n:28) the following data were collected: surgical complications, clinical symptoms, pH-metric and manometric data, before and 4 and 28 months after operation.
Results: Rates of perioperative complications were 26% and 7% in the Nissen and Toupet groups respectively. The Nissen induced more late complications (14%) than the Toupet (0%). At early postoperative evaluation (mean follow-up: 4 months), the rates of clinical and pH-metric recurrences were 2% and 2.5% respectively in the Nissen group and 4% and 9% in the Toupet group (NS). Thirty-seven percent of the patients in the Nissen group and 38% in the Toupet group experienced dysphagia (NS). Disturbances in oesophageal motility, which were present in both groups before surgery, were not significantly modified. At the late evaluation (mean follow-up 28 months), some symptoms of reflux were present in 8% and 17% of patients of the Nissen and Toupet groups respectively (NS). The pH-metric recurrence rate was 10% versus 44% in the Nissen and Toupet groups respectively (P < 0.01). Dysphagia was present in 39% of patients in the Nissen group versus 13% in the Toupet group (P < 0.02). Oesophageal motility remained unchanged in the Nissen group whereas it was significantly improved in the Toupet group where the peristaltic velocity rose from 3.2 cm/s before surgery to 4.4 cm/s after (P < 0.05), giving a value comparable to that of controls (4.2 cm/s).
Conclusions: These results suggest that the short term effectiveness of both procedures is comparable. The effectiveness of the Nissen is more durable, but its morbidity is higher than for the Toupet. Moreover, oesophageal motility is significantly improved by the latter.