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Dor and Toupet Partial Fundoplication

Anterior and posterior partial wraps for reflux and motility disorders

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Dor and Toupet Partial Fundoplication?

Partial fundoplication uses a portion of the gastric fundus to create an antireflux barrier without complete circumferential wrap.

Dor fundoplication is an anterior 180-degree wrap that covers the front of the distal esophagus and is most commonly used after Heller myotomy for achalasia.

Toupet fundoplication is a posterior 270-degree wrap that leaves the anterior surface of the esophagus uncovered, used for GERD with impaired esophageal motility.

Both procedures provide reflux control while reducing the risk of post-fundoplication dysphagia and gas-bloat syndrome compared to complete (Nissen) wraps.

They are typically performed laparoscopically, with similar long-term reflux control to Nissen but better functional outcomes in patients with motility issues.

Symptoms

Indications include GERD refractory to medical therapy, GERD with esophageal dysmotility, after Heller myotomy for achalasia
Pre-operative symptoms: heartburn, regurgitation, dysphagia, chest pain, chronic cough, asthma exacerbation, hoarseness
Post-operative: improvement in reflux symptoms, less dysphagia than after Nissen, may have transient bloating or difficulty belching
Persistent or new symptoms after surgery: recurrent reflux, dysphagia, chest pain, gas-bloat, weight loss
Symptoms suggesting wrap failure: return of heartburn, slipped wrap, hiatal hernia recurrence

Risk Factors

Indications for partial over complete wrap: ineffective esophageal motility, jackhammer esophagus, achalasia post-myotomy, scleroderma esophagus, prior gastric surgery
GERD with documented motility abnormalities on manometry favoring partial wrap
Surgical risks: bleeding, infection, splenic injury, esophageal injury, vagus nerve injury, conversion to open
Patient factors: obesity (BMI greater than 35), large hiatal hernia, prior abdominal surgery

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent severe dysphagia beyond 4–6 weeks after surgery
  • Recurrent heartburn, regurgitation or chest pain
  • Inability to belch or vomit with severe bloating
  • Significant weight loss or inability to advance diet
  • Fever, abdominal pain, vomiting suggesting complication
  • Symptoms of wrap herniation, slippage or breakdown
  • Worsening reflux symptoms after initial improvement

Treatment Methods

01
Pre-operative workup: upper endoscopy, esophageal manometry, 24-hour pH monitoring, barium swallow, gastric emptying study if symptoms suggest delay
02
Multidisciplinary discussion to choose between partial (Dor or Toupet) vs complete (Nissen) wrap based on motility findings
03
Laparoscopic approach with 5 ports; mobilize fundus, divide short gastric vessels, dissect distal esophagus and crura
04
Crural closure with non-absorbable sutures to repair hiatal hernia
05
Dor: anterior 180-degree wrap sutured to right crus and esophageal wall — preferred after Heller myotomy
06
Toupet: posterior 270-degree wrap sutured to right and left crura and esophageal wall — preferred for GERD with motility disorder
07
Avoid creating a tight wrap; ensure intra-abdominal esophagus length of at least 2.5–3 cm
08
Post-operative liquid diet for 1–2 weeks, advance to soft and then regular diet over 4–6 weeks
09
Long-term follow-up: assess symptom control, manometry and pH study if recurrent symptoms
10
Re-operation if wrap failure with persistent severe symptoms despite optimization

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.