Nissen fundoplication versus Toupet fundoplication on postoperative manometry findings

When comparing Nissen fundoplication (LNF) and Toupet fundoplication (LTF) based on postoperative manometry findings, the following distinctions emerge:

1. **Improvement in LES Pressure:**

• Both Nissen and Toupet fundoplications significantly increase lower esophageal sphincter (LES) pressure after surgery. This confirms that both procedures are effective in controlling gastroesophageal reflux by improving the barrier function of the LES.

2. **Esophageal Motility Outcomes:**

• Toupet fundoplication (LTF) demonstrates better outcomes in terms of esophageal motility parameters compared to Nissen fundoplication (LNF). Specifically:
• LTF leads to a **larger reduction in break size** (a measure of esophageal peristaltic integrity).
• LTF results in a **greater increase in distal contractile integral (DCI)**, which reflects the strength and coordination of esophageal contractions.
• These findings suggest that LTF has a more favorable impact on preserving or improving esophageal motility, making it particularly advantageous for patients with pre-existing borderline or impaired esophageal motility.

3. **Clinical Implications:**

• While both procedures improve reflux control through increased LES pressure, the superior motility outcomes observed with LTF may explain why it is associated with fewer obstructive side effects, such as dysphagia (difficulty swallowing) or gas-bloat syndrome, compared to LNF.
• As a result, Toupet fundoplication is often considered the preferred option for patients with compromised esophageal motility, as it achieves a balance between effective reflux control and preservation of esophageal function.

In summary, while both surgeries improve LES pressure, Toupet fundoplication offers better postoperative esophageal motility outcomes, making it a more suitable choice for certain patient populations.