Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux

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Abstract
The importance of the extent of the fundic wrap that encircles the distal oesophagus for the establishment of long‐term control of gastro‐oesophageal reflux disease (GORD) and for the risk of symptoms after fundoplication was evaluated in a prospective, randomized clinical trial. Of 137 consecutive patients with GORD, 72 were allocated to a semifundoplication (180–200°, Toupet) and 65 to a total fundoplication (360°, Nissen–Rossetti). Dysphagia was more common in the early postoperative period after a total fundic wrap, a difference which disappeared with time. This corresponded to a higher resting tone in the lower oesophageal sphincter area. Seven patients (5 per cent) experienced relapse of GORD during follow‐up of more than 3 years. Although no difference in the cumulative relapse rate (5 per cent for Nissen–Rossetti versus 6 per cent for Toupet) was found between the two study groups, the total failure rate was higher (PPP<0·01 at 3 years). Both Nissen–Rossetti and Toupet fundoplication equally well and durably controlled GORD. Fewer symptoms occurred in those having a semifundoplication, both in the early and late postoperative period.
Funding Information
  • Swedish Medical Research Council (17X-760)