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Toupét Fundoplication for Gastroesophageal Reflux in Childhood
Thomas R. Weber, MD
Arch Surg. 1999;134:717-720.
Hypothesis Gastroesophageal reflux (GER) is a common condition in childhood that frequently requires operative treatment. The 360° 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 Toupét fundoplication (TF), a 270° posterior wrap originally described in conjunction with myotomy for achalasia, has fewer complications, and its long-term outcome in children compared with NF is favorable.
Design Nonrandomized controlled trial.
Setting Tertiary care children's hospital.
Patients 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).
Intervention Operative repair of GER disease by either NF or TF.
Main Outcome Measures 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.
From the Division of Pediatric Surgery, Department of Surgery, Cardinal Glennon Children's Hospital and St Louis University Health Sciences Center, St Louis, Mo.
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