Partial posterior wrap (toupet)in patients with defective esophageal body motility.
BACKGROUND
The effectiveness of partial posterior wrap (Toupet procedure) in patients with defective esophageal body motility is controversial.


OBJECTIVE
To evaluate the effect of Toupet procedure upon the outcome of laparoscopic (LF) and open (OF) fundoplications in gastroesophageal reflux disease (GERD) patients with defective esophageal body motility.


METHODS
This study included 32 patients with severe GERD who underwent Toupet procedure; 18 (56.25%) OF 'and 14 (43.75%) LF. Outcome measures included assessment of relief of the symptoms, results of repeated endoscopy, barium study, manometry and pH metry; both early (within six months) and late (two years at least).


RESULTS
Relief of heartburn was achieved in 26 patients (81.3%). These include 14 (77.7%) and 12 (85.7%) patients who underwent OF and LF respectively. Occasional dysphagia developed in six patients (18.7%) early, and three (9.4%) late; all were managed conservatively. Endoscopic esophagitis healed in 26 patients (81.3%); 14 (77.7%) OF and 12 (85.7%) LF. Mean LES and body pressures improved (10.5 to 17.7 and 29.0 to 41.0 mmHg respectively). Persistent acid reflux was detected in six patients (18.7%); two (22.3%) OF and two (14.3%) LF.


CONCLUSIONS
Toupet fundoplication is an effective procedure for reflux control except in patients with severe GERD.
Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
Nabil Ali Gad
NA
El-Hak
Mostafa Abo
MA
Zeid
Ahmed
A
Aboelemen
Amjad
A
Fouad
Talat
T
Abd Alla
Mohamed
M
El Shoubary
Tharout
T
Kandel
Emad
E
Hamdy
Mohamed
M
Abdel Wahab
Omar
O
Fathy
Gamal
G
El Ebidy
Ahmed
A
Sultan
Amjad
A
Elfiky
Nabih
N
Elghwalby
Farouk
F
Ezzat