Postoperative outcomes of antireflux surgery in lung transplant recipients

Gastroesophageal reflux disease (GERD) is a risk factor for aspiration and lung allograft rejection. Antireflux surgery (ARS) can be performed for these patients to improve GERD and to abate lung function decline. Accordingly, this study aimed to compare the efficacy of different accepted ARS techniques in lung transplant populations.

A single-center retrospective cohort study of lung transplant recipients who underwent ARS between 2011 and 2023 was performed. GERD symptoms were based on proton pump inhibitor (PPI) usage postoperatively. In addition, pulmonary function testing, postoperative complications, dysphagia complaints, and endoscopic or surgical revisions were evaluated and compared using chi-square and Wilcoxon rank-sum tests. A P value of ≤.05 was considered significant.

A total of 96 patients underwent Nissen (49.0%), Toupet (46.9%), or Dor (1.0%) fundoplication or magnetic sphincter augmentation (3.1%). Compared with patients who underwent Toupet fundoplication, those who underwent Nissen fundoplication had increased rates of PPI usage at 3 months (54.8% vs 93.0%, respectively; P <.001) and 6 months (40.5% vs 90.7%, respectively; P <.001) postoperatively, with no significant differences at the most recent follow-up. Between patients who underwent Nissen fundoplication and those who underwent Toupet fundoplication, differences in the rates of postoperative dysphagia (45.7% vs 42.2%, respectively; P =.678), endoscopic dilation (17.4% vs 22.2%, respectively; P =.219), and revisional surgery (8.7% vs 2.2%, respectively; P =.140) were statistically insignificant. No significant differences in forced expiratory volume in 1 second (FEV1) or the median FEV1% change before and after ARS were identified between Nissen and Toupet fundoplications (FEV1: 1.98 vs 2.04 L, respectively; P =.470; FEV1% change: 1.96% vs 0.98%, respectively; P =.524).

Considering the lower PPI usage at 3 and 6 months after ARS, Toupet fundoplication was superior to Nissen fundoplication in terms of decreasing PPI use in lung transplant recipients. Postoperative dysphagia, reintervention, and pulmonary function outcomes were similar between patients who underwent Toupet fundoplication and those who underwent Nissen fundoplication.