Overview
A partial wrap for a careful balance.
The Toupet fundoplication is a partial, 270-degree anti-reflux wrap. Where the Nissen wraps the upper stomach completely around the lower esophagus, the Toupet leaves the anterior portion of the esophagus uncovered. The result is durable reflux control with a meaningful margin of safety for swallowing — which makes it the right operation for patients whose esophageal motility is weak, who have a coexisting swallowing problem, or who are undergoing a Heller myotomy for achalasia and need anti-reflux protection without obstructing the just-cut sphincter.
In numbers: approximately 80–85% of carefully selected Toupet patients have durable, satisfactory reflux control years after surgery — slightly below the Nissen's 85–90% — in exchange for noticeably less postoperative dysphagia. We perform the operation robotically through five small incisions, with the same diaphragmatic repair and the same testing protocol (EGD, manometry, pH study) as a Nissen. The decision between Toupet and Nissen is made together in the office, with your manometry results in hand.
Who is a candidate?
The Toupet is the right operation for patients with confirmed reflux disease and weak or disordered esophageal motility on manometry, for patients with coexisting dysphagia, and for those receiving a Heller myotomy for achalasia who need a partial wrap to prevent reflux. We also use it in selected patients with prior fundoplication failure, scleroderma involving the esophagus, or large hiatal hernias where a full wrap would over-tighten the outflow. Patients with normal motility and no dysphagia are usually steered toward a Nissen for marginally better reflux control.
How we perform it
Under general anesthesia, five small ports are placed in the upper abdomen. We mobilize the lower esophagus, reduce any hiatal hernia, and approximate the diaphragmatic crura around the esophagus with sutures. The short gastric vessels are divided to fully free the fundus. The fundus is brought behind the esophagus and sutured to the right and left crura and to the esophageal wall, creating a 270-degree posterior cuff. A calibrating bougie is used inside the esophagus during the wrap to ensure the right tension. The operation takes 90–150 minutes.
Recovery
Most patients spend one night in the hospital. You will walk the evening of surgery and begin clear liquids. The diet advances over six weeks — full liquids the first week, soft foods through week four, then solids — to allow the wrap to settle. Dysphagia in the first few weeks is normal and almost always resolves. Most patients are off PPIs at discharge. Desk work resumes at 7–10 days, full activity at 2–3 weeks. Follow-up at 2 weeks, 3 months, and 1 year in our Coral Springs office.
Why Florida Surgical
Choosing between Nissen and Toupet is one of the most consequential decisions in foregut surgery, and we take it seriously. Every Toupet candidate gets a complete pre-operative workup, the operation is performed robotically with careful attention to wrap geometry and crural closure, and the surgeon who plans your case is the surgeon at the console. Dr. Shaw and Dr. Decio have advanced foregut training and personally review every manometry and pH study with you before surgery.
Frequently asked questions
Why a Toupet instead of a Nissen?
A Toupet wraps only 270° posteriorly, leaving the front of the esophagus uncovered. It is gentler on swallowing and is the right choice when manometry shows weak or disordered esophageal motility, when there is a pre-existing swallowing problem, or as part of a Heller myotomy for achalasia.
How effective is a Toupet for reflux?
Approximately 80–85% of carefully selected patients have durable, satisfactory reflux control. Most stop their PPI medications. The trade-off versus Nissen is slightly less robust reflux control in exchange for noticeably less postoperative dysphagia.
Will I be able to swallow normally?
Yes. The Toupet is specifically designed to control reflux while preserving swallowing comfort. Mild dysphagia in the first few weeks is normal as swelling resolves; almost all patients eat a regular diet by six weeks.
Do I need testing before surgery?
Yes — every fundoplication patient gets an EGD, an esophageal manometry, and a 48-hour Bravo pH study. The manometry is what determines whether a Toupet or Nissen is the right operation for your anatomy.
Is the operation reversible?
Yes. If significant problems develop the wrap can be taken down or revised. Reoperation is uncommon — about 5% of patients within ten years.