RT Journal
A1 Weber TR
T1 TOupét fundoplication for gastroesophageal reflux in childhood
JF Archives of Surgery
JO Archives of Surgery
YR 1999
FD July 1
VO 134
IS 7
SP 717
OP 720
DO 10.1001/archsurg.134.7.717
UL http://dx.doi.org/10.1001/archsurg.134.7.717
AB Hypothesis 
    Gastroesophageal reflux (GER) is a common condition in childhood that frequently requires operative treatment. The 360° 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 Toupét fundoplication (TF), a 270° posterior wrap originally described in conjunction with myotomy for achalasia, has fewer complications, and its long-term 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.