Partial poterior wrap.doc

Partial posterior wrap (toupet)in patients with defective esophageal body motility Nabil Ali Gad El-Hak, Mostafa Abo Zeid, Ahmed Aboelemen, Amjad Fouad, Talat Abd alla, Mohamed El Shoubary, Tharout Kandel, Emad Hamdy, Mohamed Abdel Wahab, Omar Fathy, Gamal El Ebidy, Ahmed Sultan, Amjad Elfiky, Nabih Elghwalby, Farouk Ezzat?Gastroenterology Surgical Center, Mansoura University, Mansoura, EgyptAbstract Background: The effectiveness of partial posterior wrap (Toupet procedure) in patients with defective esophageal body motility is controversial. Aim of the study: To evaluate the effect of Toupet procedure upon the outcome of laparoscopic (LF) and open (OF) fundoplications in gastroesophageal reflux disease (GERD) patients with defective esophageal body motility. Patients and Methods: This study included 32 patients with severe GERD who underwent Toupet procedure; 18 (56.25%) OF and 14 (43.75%) LF. Outcome measures included assessment of relief of the symptoms, results of repeated endoscopy, barium study, manometry and pH metry; both early (within six months) and late (two years at least).Results: Relief of heartburn was achieved in 26 patients (81.3%). These include 14 (77.7%) and 12 (85.7%) patients who underwent OF and LF respectively. Occasional dysphagia developed in six patients (18.7%) early, and three (9.4%) late; all were managed conservatively. Endoscopic esophagitis healed in 26 patients (81.3%); 14 (77.7%) OF and 12 (85.7%) LF. Mean LES and body pressures improved (10.5 to 17.7 and 29.0 to 41.0 mmHg respectively). Persistent acid reflux was detected in six patients (18.7%); two (22.3%) OF and two (14.3%) LF. Conclusion: Toupet fundoplication is an effective procedure for reflux control except in patients with severe GERD Keywords:?Partial posterior wrap, Toupet procedure, defective body motility. How to cite this article:El-Hak NA, Zeid MA, Aboelemen A, Fouad A, Abd alla T, El Shoubary M, Kandel T, Hamdy E, Wahab MA, Fathy O, El Ebidy G, Sultan A, E