Which fundoplication procedures are most commonly used in the United States for severe reflux?

Which fundoplication procedures are most commonly used in the United States for severe reflux?

• A. Nissen fundoplication and Toupet fundoplication
• B. Thai fundoplication and Nissen fundoplication
• C. Belsey-Davis fundoplication and Hill repair
• D. Dor fundoplication and Nissen fundoplication

Answer: (B)

In severe reflux, the procedures most commonly used in the United States are a full 360-degree wrap and a partial posterior wrap. The full wrap, Nissen fundoplication, creates a durable barrier to reflux and is highly effective when esophageal motility is adequate. The partial posterior wrap, Toupet fundoplication, preserves more of the esophagus’s natural movement, which can reduce the risk of swallowing difficulties in patients with weaker esophageal motility. Together, they balance strong reflux control with preserving function, making them the go-to choices for most US surgeons. Other older or alternative approaches exist, such as Belsey-Davis or Hill repairs, but they’re used less often today due to less favorable outcomes or different mechanisms of addressing reflux. Dor fundoplication is less common and typically tailored to specific situations. Thai fundoplication is not a standard approach in the United States, and thus is not part of the typical repertoire for treating severe reflux.

In severe reflux, the procedures most commonly used in the United States are a full 360-degree wrap and a partial posterior wrap. The full wrap, Nissen fundoplication, creates a durable barrier to reflux and is highly effective when esophageal motility is adequate. The partial posterior wrap, Toupet fundoplication, preserves more of the esophagus’s natural movement, which can reduce the risk of swallowing difficulties in patients with weaker esophageal motility. Together, they balance strong reflux control with preserving function, making them the go-to choices for most US surgeons.

Other older or alternative approaches exist, such as Belsey-Davis or Hill repairs, but they’re used less often today due to less favorable outcomes or different mechanisms of addressing reflux. Dor fundoplication is less common and typically tailored to specific situations. Thai fundoplication is not a standard approach in the United States, and thus is not part of the typical repertoire for treating severe reflux.