Complete vs partial fundoplication: a laboratory measurement of functionality and effectiveness

Abstract

Background

Complete or partial fundoplication remains controversial for the surgical treatment of GERD. While partial fundoplication is considered less effective, it is associated with less post-operative dysphagia and gas bloating compared with complete fundoplication.

Aim

To compare the mechanical efficiency of the three different types of fundoplication.

Material and method

Two studies of the LES were performed on explanted stomachs: distensibility and failure point. Measurements were taken before and after fundoplication.

Results

There was no difference in distensibility between Nissen and Toupet fundoplication, however, the EGJ was more distensible following Dor fundoplication. According to failure point measurements, Nissen fundoplication was significantly more effective than Toupet, Toupet was significantly more effective than Dor (p = .016, p = .017, respectively).

Conclusions

There were significant differences in distensibility between Dor and both Nissen and Toupet, however no statistical difference between Toupet and Nissen. There was a significant difference in effectiveness between all three types of fundoplication according to the failure point. These laboratory findings demonstrate that the mechanical orientation of Nissen and Toupet have similar functionality suggesting that Toupet is as good as Nissen. While in clinical studies Toupet has fewer post-operative complications these findings support the proponents of Toupet for GERD. Abbreviation: GERD: Gastroesophageal reflux disease

Keywords:

• GERD
• complete fundoplication
• partial fundoplication
• distensibility
• dysphagia
• reflux

Declaration of interest

Dr. Rachel Gefen, Dr. Gad Marom, Ms. Ronit Brodie, Dr. Ram Elazary and Dr. Yoav Mintz have no conflicts of interest or financial ties to disclose.