Standard technique for laparoscopic Nissen and laparoscopic toupet fundoplication

Summary   Background: Laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication are helpful procedures to treat gastroesophageal reflux disease. Methods: Patients with an incompetent lower esophageal sphincter and an unwillingness or failure of medical treatment are optimal candidates for surgery. Careful evaluation of the patient with manometry, 24-hour pH monitoring and endoscopy is important. Results: The feasibility and the short term outcome of the laparoscopic procedure are established. There is a steep learning curve, but in the hand of experienced surgeons the mortality and morbidity is low compared to the open procedure. There is an overall satisfaction rate of 87 % to 100 %. The most frequent complications after surgery are dysphagia, which occurs in 5.5 % after fundoplication, and recurrent reflux which occurs in 3.4 %. The latter is more common after the laparoscopic Toupet fundoplication. Conclusions: Laparoscopic antireflux procedures appear to be superior to medical treatment in patients with severe reflux disease. Long term follow up data is awaited.