I need surgery for my GERD and really wanted to have the LINX procedure, but the results from my manometry didn't allow me to be a candidate for LINX. The surgeon recommended the Toupet fundoplication. What can you tell me about the procedure?
The LINX procedure is not indicated for patients who have abnormally weak function of the esophagus. This was determined by the results of the esophageal manometry study.
Learn more: Ten things you need to know about LINX
Other types of antireflux surgery are available in this setting. The most common procedure in general for resolving reflux is the laparoscopic Nissen fundoplication. With this procedure, the function of the lower esophageal sphincter, which is malfunctioning in reflux patients, is restored. This is accomplished by wrapping part of the stomach completely around the esophagus. The results of this procedure in properly selected patients are excellent. However, dysphagia (swallowing problems) can be a side effect and may be more pronounced in patients with weak esophageal function. For this reason there exists a modification of the Nissen procedure that seems to carry with it a lower risk of dysphagia, but still restores satisfactory function to the LES. This procedure is the Toupet fundoplication.
In the Toupet fundoplication, the stomach is only partially wrapped around the esophagus (about 270 degrees). Most recent studies suggest that this procedure stop reflux symptoms nearly as well as the Nissen and carries with it a lower risk of dysphagia. It is intuitive to think that if the stomach is not wrapped fully around the esophagus, side effects like dysphagia might be less. Studies suggest this. The Toupet' fundoplication is used extensively in Europe with excellent results, as well as used in the United States in settings when there is compromised esophageal function. Most antireflux surgeons agree that once esophageal function is diminished to a certain degree (usually caused by longstanding reflux), that a Toupet should at least be considered.