Toupét fundoplication for gastroesophageal reflux in childhood

Abstract

Hypothesis: Gastroesophageal reflux (GER) is a common condition in childhood that frequently requires operative treatment. The 360 degrees Nissen fundoplication (NF) has been the standard operation for GER, but is associated with substantial rates of recurrence, "gas bloat," gagging, and dysphagia. I believe that the Toupet fundoplication (TF), a 270 degrees posterior wrap originally described in conjunction with myotomy for achalasia, has fewer complications, and its longterm outcome in children compared with NF is favorable.

Design: Nonrandomized controlled trial.

Setting: Tertiary care children's hospital.

Patients: Two hundred fifty-six children (aged 3 months to 16 years) with GER disease unresponsive to nonoperative therapy who underwent either NF (n = 102) or TF (n = 154).

Intervention: Operative repair of GER disease by either NF or TF.

Main outcome measures: Time to first feeding, time to discharge from the hospital, postoperative dysphagia complications, recurrence, and rehospitalization and reoperation rates for each fundoplication technique.

Results: The 2 fundoplication techniques had equivalent recurrence rates, but TF had significantly lower rates of postoperative dysphagia (P = .008) and rehospitalization/reoperation rates (P = .005) and significantly shorter times to discharge from the hospital (P = .01) and to the first feeding (P = .02).

Conclusions: These data show that both NF and TF are effective procedures for GER in children, with acceptable recovery times and low recurrence rates. However, TF results in earlier feeding and discharge from the hospital and has a significantly lower incidence of dysphagia, gagging, and gas bloat, resulting in fewer rehospitalizations. In this population, TF seems to be superior to NF.