Toupét fundoplication for gastroesophageal reflux in childhood.
OBJECTIVE
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.


METHODS
Nonrandomized controlled trial.


METHODS
Tertiary care children's hospital.


METHODS
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).


METHODS
Operative repair of GER disease by either NF or TF.


METHODS
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.
Department of Surgery, Cardinal Glennon Children's Hospital and St Louis University Health Sciences Center, MO 63104, USA.
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Weber
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant