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Laparoscopic Toupet fundoplication for gastroesophageal reflux disease and hiatus hernia: proposal for standardization using the “critical view” concept

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Abstract

Laparoscopic Toupet fundoplication has gained progressive consideration in the management of patients with gastroesophageal reflux disease and hiatus hernia. Previous studies showed equivalent results in terms of reflux control with lower rate of side effects compared to the Nissen fundoplication. However, multiple technical variations may account for the long-lasting reputation of decreased durability and poor long-term reflux control. Inspired by the “critical view” concept, a step-by-step laparoscopic Toupet fundoplication is described and illustrated. During the study period, 2012–2017, 348 consecutive patients underwent laparoscopic Toupet fundoplication according to a standardized procedure. A large hiatus hernia was present in 39% of patients, and 14% had volvulus of the intrathoracic stomach. Sixty-four (18.4%) patients had one or more previously failed antireflux procedures. The median follow-up was 37 months (range 12–61). The Gastroesophageal Reflux Disease Health-Related Quality of Life score significantly improved compared to baseline (p < 0.001), and 77% of patients were off proton-pump inhibitors. The proposed standardization of the Toupet fundoplication based on a “critical-view” concept may help to improve reproducibility, clinical outcomes, and teaching of this procedure.

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Acknowledgements

This work was supported by the Associazione Italiana Ricerca Esofago (AIRES).

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Authors and Affiliations

  1. Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy

    Emanuele Asti & Luigi Bonavina

  2. General Surgery, Istituto Clinico Sant’Ambrogio, Milano, Italy

    Davide Bona & Alberto Aiolfi

Authors
  1. Davide Bona
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  2. Alberto Aiolfi
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  3. Emanuele Asti
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  4. Luigi Bonavina
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Correspondence to Luigi Bonavina.

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The authors declare that they have no conflicts of interest.

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Institutional Review Board (IRB) approved the study (Protocol HSD 0044,2018).

Research involving human participants and/or animals

The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all patients prior to all surgical procedures.

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Bona, D., Aiolfi, A., Asti, E. et al. Laparoscopic Toupet fundoplication for gastroesophageal reflux disease and hiatus hernia: proposal for standardization using the “critical view” concept. Updates Surg 72, 555–558 (2020). https://doi.org/10.1007/s13304-020-00732-7

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