107 Meta-Analysis and Systematic Review of Nissen Fundoplication Versus Toupet Fundoplication: Long-Term Functional Outcomes in Gastroesophageal Reflux Disease

Abstract Aim Nissen fundoplication (NF), a complete 360° wrap, is widely used in surgical practice and is associated with some postoperative side effects, whilst Toupet fundoplication (TF), a partial posterior 270° wrap, aims to reduce such complications. This study compares the long-term functional outcomes of NF versus TF in adult patients. Method A literature search of PubMed, Embase, and the Cochrane Library was conducted up to January 2025 in line with PRISMA guidelines. Only randomised controlled trials (RCTs) comparing NF and TF with a minimum follow-up of 12 months were included. Studies had to report at least one of the following outcomes: reflux recurrence, heartburn, dysphagia, chest pain, inability to belch, or gas bloating. A random-effects model was used. Heterogeneity was assessed using the I² statistic. Results Ten RCTs met inclusion criteria, enrolling 1,698 patients—878 underwent NF and 820 underwent TF. Toupet fundoplication was associated with significantly fewer postoperative complications. The incidence of dysphagia was significantly lower in the TF group (p = 0.0008), as were rates of gas bloating (p = 0.009) and inability to belch (p < 0.001). In contrast, no statistically significant differences were observed in reflux recurrence (p = 0.27), heartburn (p = 0.30), or chest pain (p = 0.83). Conclusions Both Nissen and Toupet fundoplication offer comparable long-term control of reflux. However, Toupet fundoplication is superior in minimising postoperative complications and should be considered for all patients or in those prioritising functional outcomes. TF provides significant fewer side effects than NF, whilst maintaining equal surgical outcomes of reflux control.