THE PROCEDURE

The Laparoscopic Toupet requires highly specialized extensive training. There are very few surgeons in the United States that perform this surgical procedure. Dr. Neil Floch is recognized as a highly skilled laparoscopic surgeon with extensive experience and one of the most prominent surgeons in the country that is performing it. He has written and published several book chapters and papers on this subject that other surgeons are using as reference and guidance in performing the procedure and treating their patients.

The Laparoscopic Toupet Fundoplication is one of the surgical procedures for the treatment of GERD (gastroesophageal reflux disease). When GERD can no longer be controlled with medication and lifestyle changes the Toupet is performed. Patients experiencing GERD have a burning sensation from the chest to the throat, and often into the jaw, because acid flows back into the stomach from the esophagus. This acid flow is caused by a weak valve muscle between the stomach and the esophagus. The purpose of this procedure is to strengthen that valve between the stomach and the esophagus.

The Laparoscopic Toupet is a partial fundoplication. It is perfect for patients whose motility shows that their esophagus has limited ability to propel food and water down its length. A partial fundoplication (Toupet) will create a strong enough valve to prevent acid and bile from refluxing back into the esophagus while preventing the difficulty with swallowing that some patients have after a Nissen Fundoplication.

Patients will undergo manomity. If the test shows that the esophagus is weak, then they may opt for a partial fundoplication. Alternately many patients may opt for a partial fundoplication because of the lower risk of difficulty swallowing and gas bloat syndrome.

The floppy portion of the upper stomach is partially wrapped around the esophagus to create a valve. This is the valve that prevents the reflux of stomach acid into the esophagus. The stomach, like a hot dog bun sits under the esophagus (the hot dog). Our surgeons use small incisions to enter the abdomen. The laparoscope, a thin telescope-like instrument, is connected to a tiny camera and then inserted through the small incision. This enables our surgeons to have a magnified image of the patient’s internal organs projected on high definition television screens in the operating room. This affords our surgeons the opportunity of having a better view of internal organs in greater detail than the traditional open procedure provides. The abdomen is inflated with gas, causing it to expand, and thereby allowing our surgeons to view the abdominal cavity and perform the procedure. The floppy portion of the upper stomach is placed behind the esophagus after which the esophagus is sewn to the stomach on either side. It is also attached to the diaphragm muscle that separates the abdominal and chest cavity

BENEFITS OF THE LAPAROSCOPIC TOUPET

• 5 tiny scars instead of one large abdominal scar. Improved cosmetic result
• Reduced post-operative pain
• Shorter hospital stay. 0- 1 days
• Faster return to work
• Less risk of complications than the Nissen Fundoplication; such as gas bloat and difficulty swallowing

RISKS OF THE LAPAROSCOPIC TOUPET

While this procedure is relatively safe, there are some risk factors that are not the norm, but the potential for them does exist.

• Reaction to anesthesia
• Infection
• Bleeding
• Difficulty in swallowing
• Injury to the esophagus
• Injury to the spleen
• Recurrence of GERD
• Gas bloat syndrome which is usually temporary in 10- 20%
• Bloating
• Flatus
• Inability to vomit
• Inability to burp

BEFORE SURGERY

Please contact your insurance company to determine your benefits. If you require help, one of our patient advocates will assist you. Our surgeons will pre-screen you and your condition will be thoroughly analyzed to make certain that you are an appropriate candidate for the procedure. Blood tests will be ordered as well as any other tests that our surgeons feel are necessary in evaluating your condition and eligibility.

DAY OF SURGERY

PRE-SURGERY – You will report to a pre-operative area where a nurse will review your chart and make certain that all of the necessary paper work is correct and present. Dr. Floch will meet with you, discuss the process and answer any questions you may have. The anesthesiologist will conduct a pre-operative interview including questions concerning your medical history. Once everything has been confirmed and you are ready to proceed, the anesthesiologist will begin the IV. Then it’s off to the operating room where the anesthesia is administered and the operation is performed. The Laparoscopic Toupet is performed under general anesthesia so you will be asleep for the entire procedure.

POST SURGERY – After the surgery is completed, you will be taken to a recovery unit where your recovery will be monitored by the nursing staff. You can anticipate spending one night in the hospital. However, this will depend on your condition and our surgeon’s evaluation. No one is sent home unless our surgeon is completely comfortable making the decision to do so. If it is determined that there is a need to keep you for an additional day, or days, you will remain in the hospital. You must provide for someone to drive you home when you are discharged. Generally the LT requires a one-night stay.

Pain sometimes has a tendency to appear at the incision sight and our surgeon will prescribe medication for it in the event you are faced with this issue.

AT HOME

WHAT CAN I EXPECT?

• Light activity is encouraged while recuperating at home
• Most often postoperative pain is mild. Some patients may have need for prescription pain medication
• Normal activities should begin in 1-2 days
• There may be temporary difficulty in swallowing, but that will resolve within one to two months after surgery
• Your diet will be a pureed or mashed food diet
• We will see you in the first week and advance your diet to include pasta and fish and then to more solid foods

WHEN SHOULD I CALL THE DOCTOR?

It is not often the case, but you may experience symptoms other than general discomfort and mild pain. If the following symptoms persist than we ask that you call us:

• Abdominal swell or pain that continues to increase
• Persistent nausea and vomiting
• Continuous chills or a continuous fever of 1000
• Drainage from the incisions
• Constant cough or shortness of breath