Background: Gastroesophageal reflux disease (GERD) is a prevalent condition with significant impact on quality of life. When medical therapy fails, surgical intervention—most commonly Nissen (NF) or Toupet fundoplication (TF)—is indicated. The optimal technique, however, remains debated. Aim: To compare the efficacy, functional outcomes, and complication profiles of Nissen and Toupet fundoplication in the surgical management of GERD. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Cochrane, SciELO, and LILACS databases were searched for studies published between 2002 and 2025. Randomized controlled trials and cohort studies comparing NF and TF with at least 12 months of follow-up were included. Primary outcomes were postoperative dysphagia and reflux control. Secondary outcomes included proton pump inhibitor (PPI) use, quality of life (QoL), patient satisfaction, and reoperation rates. Results: Nine studies comprising 2,130 patients were included, including six randomized controlled trials. Both techniques provided effective and sustained reflux control. Nissen fundoplication demonstrated higher postoperative lower esophageal sphincter pressure and slightly better objective acid suppression in some studies; however, this did not translate into superior long-term clinical outcomes. Toupet fundoplication was associated with lower rates of early postoperative dysphagia and better preservation of esophageal motility. Long-term outcomes—including PPI use, QoL, and patient satisfaction—were comparable between techniques. Differences in dysphagia diminished over time. Conclusion: Nissen and Toupet fundoplication offer equivalent long-term control of GERD. While NF provides greater sphincter augmentation, TF achieves similar clinical outcomes with fewer early functional side effects. Surgical decision-making should prioritize esophageal motility and patient-specific characteristics rather than maximal acid suppression alone.
Lisboa et al. (Tue,) studied this question.