Pearson's General Thoracic
Laparoscopic Toupet Fundoplication
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Key Points
- Laparoscopic Toupet repairs represent the second most common antireflux surgery.
- The primary indication for partial fundoplication is for reflux in patients with primary motility disorders.
- Use of the Toupet repair as a primary repair in patients with normal motility is controversial.
- The original 180-degree repair described by Andre Toupet has been modified and is usually a 270-degree or more fundoplication with crural closure.
There has been a general trend over the past several decades toward the use of the “floppy Nissen” as the primary antireflux surgery for all patients with gastroesophageal reflux. Partial fundoplications, were thought to be necessary for any degree of esophageal dysmotility and to be a more physiologic alternative to a 360-degree wrap. Partial fundoplications such as the Toupet procedure are, however, universally used as an adjunct to Heller myotomy for severe esophageal dysmotility. Even though the “tailored approach” has become less popular there are centers with a long experience in use of the Toupet repair that report excellent long-term results. It is therefore recommended that surgeons with an interest in antireflux surgery be familiar with the laparoscopic Toupet procedure so that they have this “tool” in their armamentarium when it is needed.
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Key Points
- Laparoscopic Toupet repairs represent the second most common antireflux surgery.
- The primary indication for partial fundoplication is for reflux in patients with primary motility disorders.
- Use of the Toupet repair as a primary repair in patients with normal motility is controversial.
- The original 180-degree repair described by Andre Toupet has been modified and is usually a 270-degree or more fundoplication with crural closure.
There has been a general trend over the past several decades toward the use of the “floppy Nissen” as the primary antireflux surgery for all patients with gastroesophageal reflux. Partial fundoplications, were thought to be necessary for any degree of esophageal dysmotility and to be a more physiologic alternative to a 360-degree wrap. Partial fundoplications such as the Toupet procedure are, however, universally used as an adjunct to Heller myotomy for severe esophageal dysmotility. Even though the “tailored approach” has become less popular there are centers with a long experience in use of the Toupet repair that report excellent long-term results. It is therefore recommended that surgeons with an interest in antireflux surgery be familiar with the laparoscopic Toupet procedure so that they have this “tool” in their armamentarium when it is needed.
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