Toupet Fundoplication

Toupet Fundoplication

What is Toupet Fundoplication?

Toupet fundoplication is a minimally invasive surgical procedure used to treat gastroesophageal reflux disease and hiatal hernias.

GERD is a condition where the stomach acid leaks into your food pipe (esophagus), causing a burning sensation in your chest and other associated symptoms.

A hiatal hernia occurs when part of the stomach pushes up into the chest through an opening (hiatus) in the diaphragm (a muscle that separates the chest cavity from the abdominal cavity), often causing symptoms like acid reflux, chest discomfort, or difficulty swallowing.

Normally, the stomach contents do not enter the esophagus because the lower esophageal sphincter (LES) holds this lower end of the pipe closed. In patients with GERD, the LES becomes weakened or relaxed, enabling stomach acids to travel up into the esophagus.

Toupet fundoplication is a partial (270-degree) posterior fundoplication procedure, meaning that the upper part of the stomach (called the fundus) is wrapped partially around the back (posterior) of the lower esophagus. It reinforces the LES, reducing the likelihood of acid reflux while preserving the ability to belch and vomit.

What are the Indications for Toupet Fundoplication?

Toupet fundoplication is typically performed:

• When a patient has GERD that does not respond to medication
• When there is a weakened or poorly functioning esophagus, where a full wrap (360-degree) fundoplication, like Nissen might cause swallowing difficulties
• To repair a hiatal hernia along with controlling reflux

What Does the Procedure for Toupet Fundoplication Involve?

Toupet fundoplication is typically performed laparoscopically (minimally invasive) under general anesthesia and involves the following steps:

• The patient is given general anesthesia.
• The abdomen is inflated with carbon dioxide (CO2) to create space for the surgery.
• 4 to 5 small incisions are made in the abdomen.
• A laparoscope (camera) and surgical instruments are inserted through these incisions.
• If a hiatal hernia is present, the stomach is gently pulled back into the abdomen.
• The esophageal hiatus (opening in the diaphragm) is tightened using sutures.
• The fundus (upper part of the stomach) is mobilized by freeing it from surrounding attachments, such as the short gastric vessels.
• The fundus is wrapped partially (270 degrees) around the back (posterior side) of the lower esophagus.
• It is then sutured in place to create a valve-like mechanism, reinforcing the lower esophageal sphincter (LES).
• The instruments are removed, and the CO2 is released.
• The small incisions are closed with sutures or surgical glue.

What Does Postoperative Care for Toupet Fundoplication Involve?

Postoperative care for Toupet fundoplication involves monitoring the patient for complications, managing pain, and gradually reintroducing food. Patients typically stay in the hospital for 1–3 days, during which vital signs and swallowing ability are closely observed. Initially, a liquid diet is recommended, followed by a gradual progression to soft and then solid foods over several weeks. Patients are advised to eat small, frequent meals, avoid carbonated beverages, and chew food thoroughly. Activity should be limited in the first few weeks, avoiding heavy lifting or strenuous exercise. Follow-up visits are scheduled to ensure proper healing and evaluate symptom relief.

What are the Risks and Complications of Toupet Fundoplication?

Risks and complications of Toupet fundoplication may include:

• Difficulty swallowing (dysphagia)
• Gas-bloat syndrome
• Recurrence of reflux or hiatal hernia
• Injury to nearby structures (e.g., esophagus, stomach)
• Infection or bleeding
• Wrap migration or loosening over time
• Anesthesia-related risks

What are the Benefits of Toupet Fundoplication?

Benefits of Toupet fundoplication include the following:

• Effective relief from GERD symptoms
• Lower risk of gas bloat syndrome and difficulty swallowing compared to Nissen fundoplication
• Preserves esophageal motility, making it suitable for patients with weak esophageal muscles
• Can be performed using a minimally invasive (laparoscopic) approach, leading to quicker recovery and less postoperative pain

If you would like more information about Toupet fundoplication or are considering Toupet fundoplication surgery, please contact Chicago Surgical Clinic, dedicated to serving the communities of Arlington Heights, IL.