Comparison of Nissen vs. Toupet fundoplication in laparoscopic hiatal hernia repair for gastroesophageal reflux disease with extra-esophageal symptoms

TL;DR

This study compares two surgical techniques for treating GERD and finds both are effective in reducing symptoms and acid reflux.

Contribution

The study provides a direct comparison of Nissen and Toupet fundoplication outcomes in patients with GERD and extra-esophageal symptoms.

Findings

Both Nissen and Toupet fundoplication significantly reduced the DeMeester index postoperatively.

RSI and GERD scores improved in both groups at 12 months post-surgery.

Laparoscopic hiatal hernia repair effectively improved GERD symptoms and quality of life.

Abstract

This study aims to evaluate the clinical efficacy of laparoscopic hiatal hernia repair (LHHR) in treating gastroesophageal reflux disease (GERD) and to through the therapeutic effect of total (360°) and partial (270°) laparoscopic fundoplication.

This retrospective observational study enrolled 100 patients, both with and without documented extra-oesophageal symptoms of GERD. Data were extracted from medical records, covering basic information, symptoms, treatments, and follow-up. Symptom relief and quality of life were assessed via GERD-Q score, Reflux Symptom Index (RSI), and EORTC QLQ-C30 scale, offering a foundation for comprehensive GERD patient management and treatment evaluation in clinical practice.

The DeMeester index significantly decreased postoperatively in both the laparoscopic Nissen fundoplication (LNF) group (from 55.23 ± 25.12 to 11.45 ± 10.20, p < 0.05) and the laparoscopic Toupet fundoplication (LTF) group (from 60.51 ± 28.40 to 11.70 ± 9.65, p < 0.05). The RSI scores improved at 12 months postoperatively in both groups: LNF group (from 23.1 ± 15.4 to 13.7 ± 9.6, p < 0.05) and LTF group (from 21.9 ± 15.8 to 12.8 ± 8.2, p < 0.05). The GERD scores also improved postoperatively: LNF group (from 13 ± 5.0 to 10 ± 4.4, p < 0.05) and LTF group (from 10 ± 4.7 to 7.5 ± 4.5, p < 0.05).

Our report demonstrates that LHHR significantly improved GERD regarding symptom frequency, acid reflux occurrences and DeMeester score. Both LNF and LTF provide good results.

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