Complete Fundus Mobilization Reduces Dysphagia After Nissen Procedure

Area of Science:

• Gastroenterology
• Surgical Innovation
• Patient Outcomes

Background:

• Gastroesophageal reflux disease (GERD) management often involves anti-reflux surgery.
• Postoperative dysphagia (PD) is a significant complication, necessitating careful surgical consideration.
• Laparoscopic Nissen-Rossetti fundoplication (NRF) and floppy Nissen fundoplication (FNF) are surgical options for GERD.

Purpose of the Study:

• To compare the clinical outcomes of NRF and FNF with complete fundus mobilization in GERD treatment.
• To specifically evaluate and compare the incidence and severity of postoperative dysphagia (PD) between the two surgical techniques.
• To assess patient satisfaction, quality of life, and need for protonic pump inhibitors (PPIs) post-surgery.

Main Methods:

• Ninety GERD patients were divided into two groups: NRF (44 patients) and laparoscopic FNF with complete fundus mobilization (46 patients).
• Clinical outcomes were assessed using structured questionnaires, SF-36 quality of life scores, and a validated PD classification.
• Patient-reported overall outcomes and PPI usage were recorded at 24-month follow-up.

Main Results:

• At 24 months, 88.3% of NRF patients and 86.6% of FNF patients reported satisfaction with reflux relief and discontinued PPIs.
• Persistent PD was significantly lower in the FNF group (4.4%) compared to the NRF group (18.6%) (P = .03).
• No significant differences were observed in quality of life scores or overall patient-perceived outcomes between the two groups.

Conclusions:

• Laparoscopic floppy Nissen fundoplication with complete fundus mobilization is associated with a reduced rate of persistent postoperative dysphagia.
• Both NRF and FNF provide effective long-term GERD symptom control and improve quality of life.
• FNF may be a preferred surgical option when minimizing the risk of dysphagia is a priority in GERD treatment.