Reflux and Belching after Laparoscopic 270 degree Posterior Versus 180 degree Anterior Partial Fundoplication

• Published in: Journal of gastrointestinal surgery Vol. 22; no. 11; pp. 1852 - 1860
• Main Authors: Oor, J. E., Broeders, J. A., Roks, D. J., Oors, J. M., Weusten, B. L., Bredenoord, A. J., Hazebroek, E. J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-11-2018; Springer Nature B.V
• Subjects: Adult; Endoscopy, Gastrointestinal; Eructation - complications; Esophageal pH Monitoring; Esophagitis, Peptic; Esophagus; Female; Fundoplication - methods; Gastroenterology; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - diagnostic imaging; Gastroesophageal Reflux - physiopathology; Gastroesophageal Reflux - surgery; Gastrointestinal surgery; Heartburn; Humans; Laparoscopy; Laparoscopy - methods; Male; Manometry; Medicine; Medicine & Public Health; Middle Aged; Original Article; Surgery; Treatment Outcome; Young Adult; Fundoplication; Treatment outcome; Laparoscopy; Gastroesophageal reflux disease; Belching
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-018-3874-y

Background
Laparoscopic 270 degree posterior, or Toupet (LTF), and 180 degree anterior partial fundoplication (LAF) ensure equal reflux control and reduce the risk of gas-related symptoms compared to 360 degree (Nissen) fundoplication. It is unclear which type of partial fundoplication is superior in preventing gas-related side-effects. The aim of this study was to determine differences in effect of LTF and LAF on reflux characteristics and belching patterns.
Methods
Upper gastrointestinal endoscopy, esophageal manometry, and 24-h combined pH-impedance monitoring were performed before and 6 months after fundoplication (
n
 = 10, LTF vs.
n
 = 10, LAF). Observed changes after surgery (∆) were compared between the two procedures.
Results
Symptomatic reflux control as well as the reduction in the mean number of acid (∆ − 58.5 vs. − 66.5;
P =
 0.912), liquid (∆ − 17.0 vs. − 43.5;
P
 = 0.247), and mixed liquid gas reflux episodes (∆ − 38.0 vs. − 40.0;
P
 = 0.579) were comparable following LTF and LAF. There were no differences in the mean number of weakly acidic reflux episodes after LTF and LAF (1.0 (0.8–4) vs. 1.0 (0–3),
P =
 0.436). The reduction in proximal (
P
 = 1.000), mid-esophageal (
P
 = 0.063), and distal reflux episodes (
P
 = 0.315) was comparable. Both procedures equally reduced the number of gastric belches (
P
 = 0.278) and supragastric belches (
P
 = 0.123), with no significant reduction in the number of air swallows after either procedure (
P
 = 0.278).
Conclusion
LTF and LAF provide similar reflux control, with a comparable effect on acidic, liquid, and gas reflux. Both procedures equally reduced the number of belches and supragastric belches. This study provides the physiological evidence for the published randomized trials reporting similar symptomatic outcome after both types of partial fundoplication.