Partial Fundoplications (270° Toupet, 90° Dor)

Partial fundoplication such as the Toupet posterior 270° and the Dor anterior 90° to 180° wraps were developed with the aim of providing long-term GERD control as with the successful Nissen fundoplication, but with reduced post-operative side effects such as dysphagia and gas bloat. Randomized controlled trials with long-term follow-up show this to be the case. Failure of a fundoplication occurs along a predictable anatomical course with posterior herniation almost universal. This informs our method of dissection, hiatal repair, and wrap construction using fundopexy to the diaphragm. We present the indications and our techniques for partial fundoplication, including tips on how to reduce the incidence of fundoplication failure and recurrent reflux.