Clinical efficacy of the Toupet technique performed by laparoscopic surgery. Medium-term follow-up in 122 cases.

Background: We present the results obtained in a series of patients with gastroesophageal reflux disease (GERD) who underwent the same type of laparoscopic surgery (Toupet technique).

Methods: A total of 122 patients with symptomatic hiatal hernia and GERD were submitted to laparoscopic surgery between March 1993 and March 1999. In all patients, we performed a preoperative gastroduodenal radiological study, an upper gastrointestinal (GI) endoscopy, esophageal manometry, and 24-h pH monitoring. The same studies were repeated at 3 months. All patients were followed up clinically for ?1 year. The only laparoscopic technique used was the Toupet (270 degrees posterior fundoplication).

Results: In 117 patients (95.9%), the clinical results were good, with complete disappearance of the symptoms. Two patients suffered a relapse, which was resolved by reintervention with laparoscopy. One patient experienced dysphagia and frequent chest pain for 5 months. Another two patients had moderate difficulty in belching. The endoscopic and radiological barium studies at 3 months were normal in all patients. Significant differences were seen in functional studies performed prior to and 3 months after the operation in all patients (p < 0.05).

Conclusions: Surgical laparoscopic treatment with the Toupet technique is effective both clinically and functionally. In cases of relapse, a new repair is possible with laparoscopy. Long-term follow-up of these patients is necessary to show whether these results are maintained over time.