Toupet fundoplication could become preferred anti-reflux procedure after lung transplant
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CHARLOTTE, N.C. — Among patients who underwent lung transplantation, laparoscopic Toupet fundoplication provided objective acid reflux control and preserved lung function and foregut motility, according to late-breaking data.
“Gastroesophageal reflux disease with microaspiration is a modifiable risk factor for lung transplant rejection,” Sheetal Patel, MD, a third-year fellow in gastroenterology, hepatology and nutrition at University of Florida Health, said in her presentation at the ACG 2022 Annual Scientific Meeting. “Chronic microaspiration has been associated with acute rejection episodes and may contribute to the development of bronchiolitis obliterans, which has been implicated in chronic lung allograft dysfunction.”
She added, “These effects are compounded by the concurrent presence of esophageal dysmotility. Anti-reflux surgery with fundoplication has been proposed to prevent this GERD-induced lung damage. Nissen fundoplication has been the anti-reflux surgery of choice. It is a 360-degree wrap and has high rates of postoperative dysphagia, especially in the short-term period. The Toupet fundoplication is a less restrictive 270-degree wrap. It is just as efficacious, with lower rates of postoperative dysphagia.”
In a retrospective case series, Patel and colleagues analyzed 56 lung transplant recipients (54% women) who underwent laparoscopic Toupet fundoplication (LTF) between September 2018 and November 2020. Median study follow-up was 31.4 months.
Researchers assessed pre- and postoperative results from a 24-hour pH study (DeMeester score), a 4-hour gastric emptying study and high-resolution esophageal manometry.
According to results, the DeMeester score after LFT decreased from 32 to 3.7 (P < .0001) and the total of time with pH less than 4 decreased 7.4% to 0.5 (P < .0001). Researchers also reported that the severity of heartburn and regurgitation experienced by patients was reduced, and median gastric retention at 4 hours normalized, decreasing from 13% to 4%. There were no significant differences in bloating, distention, nausea and dysphagia before and after LFT.
With these results, Patel and colleagues noted that LFT could become the anti-reflux procedure of choice for patients who have had a lung transplant.
“Laparoscopic Toupet fundoplication is effective and safe in lung transplant recipients, affording objective acid reflux control, low rates of serious postoperative complications and foregut symptoms, and stable lung function,” Patel concluded.
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Patel S, et al. Laparoscopic Toupet fundoplication normalizes esophageal acid exposure while preserving foregut motility and lung function in lung transplant recipients. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meeting).
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