Nissen converted to Toupet 1 day after the original procedure.

We have previously published our results regarding the outcome of patients who underwent anti-reflux surgery at our centre. That series consisted 1000 consecutive patients in whom Nissen's was the procedure of choice provided that the patient had "intact" esophageal propulsive activity which was secured by routine preop manometry. In cases with mean esophageal pressures less than 20 mmHg, Toupet was the procedure of choice. This criteria resulted in 684 vs 316 Nissen's & Toupet's to be performed respectively. Interestingly; "all" patients who further required an intervention for dysphagia were in the Nissen's group. 17 Such patients required either re-laparoscopic conversion of Nissen to Toupet's (9 early, 4 late) or dilatations (4). Acute dysphagia following a Nissen procedure is a reality & requires prompt intervention. During early re-interventions as in the case presented herein; conversion to a partial fundoplication (Toupet's) should be done. As the same study showed comparable reflux control rates with both Nissen & Toupet procedures, we abandoned full fundoplications & a modified Topuet's became the procedure of choice for all patients requiring anti-reflux surgery. Doing so ; the bougie related complications & dysphagia related re-interventions will be eliminated. The same is also true for bloating.

                               
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