A Toupet or “Partial” Fundoplication is a very effective mechanism for controlling reflux. We choose to offer this type of repair when we are suspicious that the patient has a problem with their swallowing mechanism in addition to their classic reflux issues This type of repair does not apply quite as much pressure or compression on the lower esophagus as a standard Nissen fundoplication. If the Nissen procedure is a 360 degree wrapping of the stomach around the lower esophagus the Toupet is a 270 degree wrap. As we explain it to our patients is similar to releasing the top button on a tight pair of pants after a big meal. Your pants stay up but you are much more comfortable.
There are several reasons we choose this procedure over a Nissen or Linx but the most common is that the esophageal peristalsis was judged to be too weak from either patient history, radiology studies or Esophageal Function Testing/Manometry Testing in our Heartburn Center. The latter is the most accurate way to determine these problems ahead of time.
We occasionally see patients who have had anti-reflux procedures at other institutions where the patient suffers from very difficult swallowing and weight loss after the procedure. In some cases the wrap is too tight or in others we realize based on our studies that the esophagus simply doesn’t have the power to push food through the prior wrap. We will typically convert patients to the Toupet or Partial Wrap to solve the problem.