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

Abstract

<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>The DeMeester index significantly decreased postoperatively in both the laparoscopic Nissen fundoplication (LNF) group (from 55.23 ± 25.12 to 11.45 ± 10.20, <i>p</i> < 0.05) and the laparoscopic Toupet fundoplication (LTF) group (from 60.51 ± 28.40 to 11.70 ± 9.65, <i>p</i> < 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, <i>p</i> < 0.05) and LTF group (from 21.9 ± 15.8 to 12.8 ± 8.2, <i>p</i> < 0.05). The GERD scores also improved postoperatively: LNF group (from 13 ± 5.0 to 10 ± 4.4, <i>p</i> < 0.05) and LTF group (from 10 ± 4.7 to 7.5 ± 4.5, <i>p</i> < 0.05).<h4>Conclusion</h4>Our report demonstrates that LHHR significantly improved GERD regarding symptom frequency, acid reflux occurrences and DeMeester score. Both LNF and LTF provide good results.