Lap. Nissen Fundoplication leads to better respiratory Symptom Control than Toupet in the long-term of 20 years

Abstract Introduction: Since we are performing anti-reflux surgery for thirty years, it was worth re-examining our patients on the long-term to enlarge the body of evidence, if classical and extraesophageal symptoms are differently controlled by Nissen- or Toupet Fundoplication. Objectives: We report a cohort of 155 GERD patients who underwent fundoplication within a tailored approach between 1994-2000. Alterations in the perioperative functional outcome, GERD symptoms and quality of life are analyzed 10 and 20 years after the operation. Results: The operation resulted in a superior quality of life compared to a patient cohort treated with PPI therapy. We found that both surgical methods (laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication) cure classical symptoms equally (heartburn, regurgitation and dysphagia). However, GERD patients receiving a Toupet fundoplication are more likely to suffer from extraesophageal GERD symptoms 10 and 20 years after surgery than patients with a Nissen fundoplication. However, some patients with Nissen fundoplication report dysphagia even 10 and 20 years after surgery. Conclusion: The laparoscopic Nissen fundoplication seems to be superior in controlling extraesophageal reflux symptoms but at the expense of dysphagia. In summary, tailoring the operation based on symptoms seems to be advantageous.