Comparison of Partial Endoscopic vs Surgical Fundoplication after Hiatal Hernia Repair

The concomitant hiatal hernia repair with endoscopic fundoplication (c-TIF) is a novel antireflux procedure that addresses the hiatus and the gastroesophageal flap valve for surgical candidates with GERD. We aim to compare the outcomes of a TIF vs surgical partial fundoplication (anterior and posterior) with regard to quality-of-life (QoL) scores at 12 months after surgery.

Following IRB approval, a prospectively maintained antireflux database was retrospectively reviewed to identify patients who underwent a c-TIF procedure or a surgical hiatal hernia repair with partial fundoplication. The primary endpoint was QoL scores at 2, 6, and 12 months from surgery, with attention to bloating and dysphagia scores. Secondary endpoints were proton pump inhibitor (PPI) use, 30-day outcomes, operating room time and costs, reoperation within 1 year. The 3 groups were compared using ANOVA for continuous variables and Pearson's chi-square test for categorical variables. A p value of <0.05 was considered indicative of statistical significance.

Demographics between groups were similar except for age, PPI use, and presenting symptoms. There was no difference between the 3 groups with regard to postoperative QoL scores, PPI use, dysphagia, or bloating. All 3 types of fundoplication are associated with significant improvement of all symptom types, and 65% to 80% of patients are no longer using a PPI at 12 months.

There are no differences in outcomes between the c-TIF and a surgical partial fundoplication. QoL scores significantly decrease with all partial fundoplications, and there are no differences in dysphagia or bloating between the 3 types of fundoplication. Long-term data are necessary to see whether either technique provides superior control of symptoms while minimizing dysphagia and bloating.