Open Toupet and Dor Partial Fundoplications
- Open Toupet and Dor partial fundoplication are rarely performed operations with majority being performed with minimally invasive surgery techniques.
- Partial fundoplications are generally indicated in patients with impaired esophageal motility.
- Early results of partial fundoplications are good to excellent, but several series have shown a higher recurrence rate by 2 years.
- Partial fundoplications avoid overcompetence and early postoperative dysphagia.
- Dor and Toupet fundoplications aim to achieve an increase of pressure in the LES region and a long extra-abdominal segment of esophagus.
- The LES pressure created by the Dor fundoplications are lower than pressures created by the Nissen or Belsey repairs.
- It remains controversial whether avoiding early postoperative dysphagia (by performing a partial fundoplication) justifies a potentially higher recurrence rate of late postoperative reflux.
Routine open fundoplication is rarely performed with majority being performed with minimally invasive surgery techniques. The absolute indications for the open technique are limited to when a laparoscopic technique is inappropriate due to patient’s physiology and anatomy. The most likely indication for an open partial Toupet and Dor operation is when a laparoscopic approach is converted to an open one because of safety, adhesions, or complications. The Dor and Toupet antireflux procedures consist of partial anterior and posterior gastric fundoplication, respectively. It is generally believed that these partial fundoplications are indicated in patients with impaired esophageal motility. Most commonly they are described as partial wraps after myotomy for achalasia and other motor disorders of the esophagus.
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