Exploring objective factors to predict successful outcomes after laparoscopic Nissen fundoplication

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Diagnostics

Background:

• Current predictors for gastroesophageal reflux disease (GERD) symptom resolution post-fundoplication are subjective and unreliable.
• Laparoscopic Nissen fundoplication (LNF) aims to restore the structural integrity of the lower esophageal sphincter (LES).
• Identifying objective, quantitative predictors for symptom resolution is crucial for surgical success.

Purpose of the Study:

• To identify objective and quantitative preoperative predictors of symptom resolution after laparoscopic Nissen fundoplication (LNF).
• To correlate anatomical and functional parameters of the lower esophageal sphincter (LES) with patient outcomes post-surgery.
• To establish reliable indicators for successful antireflux barrier restoration.

Main Methods:

• Review of prospectively collected data from 266 patients undergoing LNF for GERD.
• Preoperative diagnosis using esophagogastroduodenoscopy, 24-h esophageal pH monitoring, and high-resolution esophageal manometry.
• Symptom assessment via validated questionnaires (Korean Antireflux Surgery Group) preoperatively and 3 months post-surgery.

Main Results:

• Analysis of 152 patients revealed longer LES length and lower Body Mass Index (BMI) predict better resolution of typical GERD symptoms (P <0.05).
• Higher LES resting pressure and a DeMeester score ≥14.7 were associated with improved atypical GERD symptoms (P <0.05).
• Specific thresholds identified: LES length >0.05 cm, BMI <23.67 kg/m², and LES resting pressure ≥19.65 mmHg for symptom resolution.

Conclusions:

• Preoperative LES length and resting pressure are significant objective predictors of symptom improvement after LNF.
• These quantitative measures can aid in patient selection and outcome prediction for anti-reflux surgery.
• Objective parameters enhance the reliability of assessing surgical success in GERD management.