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

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 6months after fundoplication (n=10, LTF vs. n=10, LAF). Observed changes after surgery (Delta) were compared between the two procedures. Results: Symptomatic reflux control as well as the reduction in the mean number of acid (Delta-58.5 vs. -66.5; P=0.912), liquid (Delta-17.0 vs. -43.5; P=0.247), and mixed liquid gas reflux episodes (Delta-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.