What Is a Toupet Fundoplication?

Marlene Garcia

Toupet fundoplication describes a form of surgery to treat severe gastroesophageal reflux disease (GERD). The operation involves wrapping the upper part of the stomach 180 degrees around the bottom part of the esophagus and stitching it in place. A toupet fundoplication might prevent stomach acid from entering the esophagus, causing heartburn. Toupet fundoplication surgery represents an older form of treatment, with the Nissen fundoplication favored by some doctors. The Nissen procedure wraps the stomach 360 degrees around the esophagus.

Patients with gastric conditions will usually respond well to Toupet fundoplication.
Patients with gastric conditions will usually respond well to Toupet fundoplication.

Studies of patients who underwent Toupet fundoplication surgery found two-thirds continued to suffer GERD symptoms shortly after surgery. The Nissen form of the operation proved more effective in reducing heartburn symptoms. Patients with gastric conditions that pass food through the stomach too quickly responded equally well to Toupet fundoplication and Nissen fundoplication.

A toupet fundoplication is generally performed through laparoscopic procedures.
A toupet fundoplication is generally performed through laparoscopic procedures.

The sphincter muscle at the lower section of the esophagus fails to close properly in GERD, allowing gastric juices or food in the stomach to enter the windpipe. Some patients with GERD also suffer from hiatal hernia, when part of the esophagus slips up into the chest cavity. Toupet fundoplication might address both conditions, and is typically performed through laparoscopic procedures.

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GERD may cause nausea and vomiting.
GERD may cause nausea and vomiting.

Surgery typically helps when medication fails to reduce symptoms of GERD. Antacids might treat mild forms of the disease and occasional symptoms. Patients who suffer more severe reactions might benefit from medication that blocks acid production in the stomach. Newer drugs work for 24 hours and relieve almost all the symptoms of GERD.

Some patients may experience abdominal bloating and pain after Toupet fundoplication.
Some patients may experience abdominal bloating and pain after Toupet fundoplication.

Toupet fundoplication might also be advised in patients with an inflamed esophagus, creating lesions or scar tissue. These lesions can develop into cancer if left untreated. The surgery might also help patients who suffer difficulty eating or swallowing due to an obstructed trachea.

Patients suffering from serious cases of GERD may require a feeding tube.
Patients suffering from serious cases of GERD may require a feeding tube.

Complications from the procedure might cause dry heaves or stomach dumping, a condition where the gut empties too fast after eating. This can lead to nutritional deficiencies because vitamins and minerals do not enter the bloodstream. Dumping might also cause cramping, nausea, or vomiting. Some patients lose the ability to pass gas orally after the operation, leading to abdominal bloating and pain.

Food might also lodge at the site of the surgery, making swallowing difficult. In some patients, scar tissue forms and might obstruct the small bowel. The Nissen form of the surgery works to ease GERD symptoms about 90 percent of the time, studies show. Laparoscopic techniques improve recovery time and cause less postoperative scarring and pain.

Toupet fundoplication may be done to treat an obstructed trachea.
Toupet fundoplication may be done to treat an obstructed trachea.

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