# 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.

## Key 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.