Meta-analysis reveals Toupet fundoplication matches Nissen fundoplication efficacy while reducing adverse effects in GERD, suggesting Toupet is a preferable surgical choice.
Key Points
To synthesize and re-evaluate the long-term efficacy and adverse outcomes of laparoscopic Nissen versus laparoscopic Toupet fundoplication for gastroesophageal reflux disease.
Conducted a systematic search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication.
Identified 13 RCTs comprising 1,564 total patients (814 undergoing laparoscopic Nissen fundoplication and 750 undergoing laparoscopic Toupet fundoplication) for meta-analysis.
Operative time, perioperative complications, patient satisfaction, reflux recurrence, and medication or reoperation rates for recurrence did not differ significantly between procedures.
Both procedures strengthened the anti-reflux barrier and elevated lower esophageal sphincter pressure, but laparoscopic Nissen fundoplication showed significantly higher rates of dysphagia, gas-bloat syndrome, inability to belch, and reoperation for severe dysphagia.
Subgroup analysis showed laparoscopic Nissen fundoplication had a significantly higher incidence of postoperative dysphagia when the wrap length was ≤2 cm, with no statistically significant difference when wrap length exceeded 2 cm.