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Comparative analysis of surgical treatments for GERD in patients with hiatal hernia: Nissen fundoplication, Toupet fundoplication, LINX, and RefluxStop™

Katarzyna Majewska

Katarzyna Majewska

Medical University of WarsawWarsaw, Poland
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Majewska, Katarzyna
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Monika Ziemba

Monika Ziemba

Medical University of WarsawWarsaw, Poland
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Ziemba, Monika
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Jakub Kamiński

Jakub Kamiński

Medical University of WarsawWarsaw, Poland
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Kamiński, Jakub
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Klaudia Malec

Klaudia Malec

University Clinical Center of the Medical University of WarsawWarsaw, Poland
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Malec, Klaudia
  
Jun 26, 2025
Comparative analysis of surgical treatments for GERD in patients with hiatal hernia: Nissen fundoplication, Toupet fundoplication, LINX, and RefluxStop™'s Cover Image
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Article Category: Review
Published Online: Jun 26, 2025
Page range: 103 - 124
DOI: https://doi.org/10.2478/bgbl-2025-0009
Keywords
© 2025 Katarzyna Majewska et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License.

Figure 1.

Nissen fundoplication, wrapping the fundus of the stomach around the lower esophagus and suturing in place. Gray JP. Nissen fundoplication.png [ilustracja]. Public domain. Wikimedia Commons; 2007 [cyt. 2025-06-08]. Dostępny na: https://commons.wikimedia.org/wiki/File:Nissen_fundoplication.png
Nissen fundoplication, wrapping the fundus of the stomach around the lower esophagus and suturing in place. Gray JP. Nissen fundoplication.png [ilustracja]. Public domain. Wikimedia Commons; 2007 [cyt. 2025-06-08]. Dostępny na: https://commons.wikimedia.org/wiki/File:Nissen_fundoplication.png

Figure 2.

The suture technique and three-point fixation with Nissen fundoplication (A); with Toupet fundoplication (B). Tzortzis N, Eleftheriadis E. Evaluation of the efficacy of partial posterior fundoplication (Toupet) in the treatment of GERD. BMC Surg. 2025;25:124.
The suture technique and three-point fixation with Nissen fundoplication (A); with Toupet fundoplication (B). Tzortzis N, Eleftheriadis E. Evaluation of the efficacy of partial posterior fundoplication (Toupet) in the treatment of GERD. BMC Surg. 2025;25:124.

Figure 3.

Schematic representation of Nissen (360°) and Toupet (270°) fundoplication techniques. Chen Y, Liu Y, Zhang R, Li X. Long-term outcomes of Toupet fundoplication in GERD patients: a retrospective cohort study. BMC Surg. 2025;25:139.
Schematic representation of Nissen (360°) and Toupet (270°) fundoplication techniques. Chen Y, Liu Y, Zhang R, Li X. Long-term outcomes of Toupet fundoplication in GERD patients: a retrospective cohort study. BMC Surg. 2025;25:139.

Figure 4.

Cross section of the LINX device in open and closed positions. Lipham, J. C., DeMeester, T. R., Ganz, R. A., Bonavina, L., Saino, G., Dunn, D. H., Fockens, P., & Bemelman, W. (2012). The LINX reflux management system: Confirmed safety and efficacy now at 4 years. Surgical Endoscopy, 26(10), 2944–2949.
Cross section of the LINX device in open and closed positions. Lipham, J. C., DeMeester, T. R., Ganz, R. A., Bonavina, L., Saino, G., Dunn, D. H., Fockens, P., & Bemelman, W. (2012). The LINX reflux management system: Confirmed safety and efficacy now at 4 years. Surgical Endoscopy, 26(10), 2944–2949.

Figure 5.

The LINX System encircling the distal esophagus in closed position (a) and in the open position (b). Bonavina, L., Saino, G., Lipham, J. C., & DeMeester, T. R. (2013). LINX® Reflux Management System in chronic gastroesophageal reflux: A novel effective technology for restoring the natural barrier to reflux. Therapeutic Advances in Gastroenterology, 6(4), 261–268.
The LINX System encircling the distal esophagus in closed position (a) and in the open position (b). Bonavina, L., Saino, G., Lipham, J. C., & DeMeester, T. R. (2013). LINX® Reflux Management System in chronic gastroesophageal reflux: A novel effective technology for restoring the natural barrier to reflux. Therapeutic Advances in Gastroenterology, 6(4), 261–268.

Figure 6.

Tunneling between the posterior vagus nerve and the esophageal wall (a), the sizing device in place to measure the esophageal circumference (b), the LINX device positioned at the gastroesophageal junction (c). Bonavina, L., Saino, G., Lipham, J. C., & DeMeester, T. R. (2013). LINX® Reflux Management System in chronic gastroesophageal reflux: A novel effective technology for restoring the natural barrier to reflux. Therapeutic Advances in Gastroenterology, 6(4), 261–268.
Tunneling between the posterior vagus nerve and the esophageal wall (a), the sizing device in place to measure the esophageal circumference (b), the LINX device positioned at the gastroesophageal junction (c). Bonavina, L., Saino, G., Lipham, J. C., & DeMeester, T. R. (2013). LINX® Reflux Management System in chronic gastroesophageal reflux: A novel effective technology for restoring the natural barrier to reflux. Therapeutic Advances in Gastroenterology, 6(4), 261–268.

Figure 7.

RefluxStop™ implant-illustration without suture, followed by assembly and suture placement. Bjelović, M., Harsányi, L., Altorjay, Á., Kincses, Z., Forsell, P., & Investigators of the RefluxStop™ Clinical Investigation Study Group. (2020). Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results. RefluxStop™ device; a new method in acid reflux surgery obtaining CE mark. BMC Surgery, 20, Article 179
RefluxStop™ implant-illustration without suture, followed by assembly and suture placement. Bjelović, M., Harsányi, L., Altorjay, Á., Kincses, Z., Forsell, P., & Investigators of the RefluxStop™ Clinical Investigation Study Group. (2020). Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results. RefluxStop™ device; a new method in acid reflux surgery obtaining CE mark. BMC Surgery, 20, Article 179

Figure 8.

The device is positioned using RefluxStop™ deployment tool. Bjelović, M., Harsányi, L., Altorjay, Á., Kincses, Z., Forsell, P., & Investigators of the RefluxStop™ Clinical Investigation Study Group. (2020). Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results. RefluxStop™ device; a new method in acid reflux surgery obtaining CE mark. BMC Surgery, 20, Article 179
The device is positioned using RefluxStop™ deployment tool. Bjelović, M., Harsányi, L., Altorjay, Á., Kincses, Z., Forsell, P., & Investigators of the RefluxStop™ Clinical Investigation Study Group. (2020). Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results. RefluxStop™ device; a new method in acid reflux surgery obtaining CE mark. BMC Surgery, 20, Article 179

Figure 9.

Optimal device placement. Top of the device placed >1 time the device size above the upper edge of the LES. Bjelović, M., Harsányi, L., Altorjay, Á., Kincses, Z., Forsell, P., & Investigators of the RefluxStop™ Clinical Investigation Study Group. (2020). Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results. RefluxStop™ device; a new method in acid reflux surgery obtaining CE mark. BMC Surgery, 20, Article 179
Optimal device placement. Top of the device placed >1 time the device size above the upper edge of the LES. Bjelović, M., Harsányi, L., Altorjay, Á., Kincses, Z., Forsell, P., & Investigators of the RefluxStop™ Clinical Investigation Study Group. (2020). Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results. RefluxStop™ device; a new method in acid reflux surgery obtaining CE mark. BMC Surgery, 20, Article 179

Figure 10.

Intraoperative placement and fixation of the RefluxStop™ device. Feka, J., Saad, M., Boyle, N., Paireder, M., Kristo, I., Rieder, E., Asari, R., & Schoppmann, S. F. (2024). Multicentric short term and safety study of ineffective esophageal motility patients treated with RefluxStop device. Scientific Reports.
Intraoperative placement and fixation of the RefluxStop™ device. Feka, J., Saad, M., Boyle, N., Paireder, M., Kristo, I., Rieder, E., Asari, R., & Schoppmann, S. F. (2024). Multicentric short term and safety study of ineffective esophageal motility patients treated with RefluxStop device. Scientific Reports.

Figure 11.

Endoscopic view of RefluxStop™ placed in a fundic pouch (from the outside). Harsányi, L., Kincses, Z., Zehetner, J., & Altorjay, Á. (2024). Treating acid reflux without compressing the food passageway: 4-year safety and clinical outcomes with the RefluxStop device in a prospective multicenter study. Surgical Endoscopy.
Endoscopic view of RefluxStop™ placed in a fundic pouch (from the outside). Harsányi, L., Kincses, Z., Zehetner, J., & Altorjay, Á. (2024). Treating acid reflux without compressing the food passageway: 4-year safety and clinical outcomes with the RefluxStop device in a prospective multicenter study. Surgical Endoscopy.
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