ArticleSurgical endoscopy2026
Nissen versus Toupet fundoplication quality-of-life outcomes compared by intraoperative EndoFLIP™ distensibility index range.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionStudies have demonstrated that Toupet fundoplications (TF) result in equitable reflux control with improved outcomes of gas-bloat compared to Nissen fundoplications (NF). Currently, it is unknown if the advantages of TF remain significant compared to NF of similar gastroesophageal junction distensibility post-fundoplication. This study aims to compare TF and NF quality-of-life (QOL) outcomes according to intraoperative endoluminal impedance planimetry (EndoFLIP) distensibility index (DI).
methodsA retrospective study was performed on a database of patients who received laparoscopic TF or NF with intraoperative EndoFLIP. Patients reported QOL using gastroesophageal reflux disease-health-related quality-of-life questionnaire (GERD-HRQL), reflux symptom index (RSI), gas-bloat score, and dysphagia surveys pre- and postoperatively at 3 weeks, 6 months, 1 year, and 2 years. Statistical analysis was conducted using Wilcoxon rank-sum and chi-square tests.
results509 patients received TF (n = 429) or NF (n = 80) between 2018 and 2024 for GERD. Paraesophageal hernias represented 81% of cases. Intraoperatively. 315 patients received DI measurement at 30 ml fill-volume, (NF n = 65 vs. TF n = 250). 441 patients received measurements at 40 mL fill (NF n = 43 vs. TF n = 398). Average post-fundoplication DI at 30 ml was lower after NF with DI 2.6 ± 1.2 mm
conclusionEndoFLIP can be used for objective measures of LES physiology after fundoplication. When compared by DI range, QOL of NF vs. TG are comparable, suggesting outcomes are dependent on post-fundoplication distensibility rather than type of fundoplication.
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