Postoperative dysphagia and short-term outcomes following laparoscopic floppy Nissen fundoplication combined with...

To compare postoperative dysphagia and anti-reflux efficacy between laparoscopic floppy Nissen fundoplication with V-flap suturing (LNF-V) and conventional laparoscopic Nissen fundoplication (LNF).

This retrospective cohort study included patients with gastroesophageal reflux disease (GERD) who underwent LNF-V or LNF between January 2022 and January 2024 at the Department of General Surgery of Xuanwu Hospital, Xiong an Xuanwu Hospital, and Beijing Feng tai Hospital of Traditional Chinese Medicine. After applying inclusion and exclusion criteria, 173 patients were enrolled, including 113 in the LNF-V group and 60 in the LNF group. In the LNF-V procedure, following the standard 360° fundoplication, the wrap was further sutured to the left and right diaphragmatic crura to form a V-shaped configuration. Saeed dysphagia scores and Gerd-Q scores were assessed preoperatively and at 3, 6, and 12 months postoperatively. Operative time, intraoperative blood loss, hospital stay, and postoperative complications were also recorded.

There were no significant differences between the two groups in baseline characteristics including sex, age, BMI, symptom duration, lower esophageal sphincter (LES) pressure, and DeMeester score (P > 0.05). Intraoperative blood loss and hospital stay were also similar. The operative time was slightly longer in the LNF-V group than in the LNF group (P < 0.001). Regarding dysphagia, Saeed scores were significantly lower in the LNF-V group at 3 to 6 months postoperatively (P < 0.001), indicating better recovery of swallowing function; by 12 months, scores were comparable between the groups (P = 0.785). Gerd-Q scores at 3 months were significantly lower in the LNF-V group (P = 0.008), reflecting better reflux symptom control, while no significant differences were observed at 6 and 12 months (P = 0.078 and 0.541, respectively).

In this retrospective cohort, LNF-V was associated with a lower incidence of early postoperative dysphagia and showed superior short-term anti-reflux efficacy compared with conventional LNF. Prospective studies are needed to confirm these findings. While the LNF-V procedure appears safe and feasible, its long-term durability requires further validation in prospective studies with extended follow-up.