Clinical and computed tomography outcome after primary and revisional fundoplication

Failure of laparoscopic fundoplication (LF) occurs in up to 10% and revisional laparoscopic fundoplication (RLF) becomes an option. Data on clinical and anatomical outcomes using computed tomography after RLF are limited.

All patients undergoing RLF for gastroesophageal reflux disease (GERD) and/or hiatal hernia (HH) between 2015 and 2022 were compared to primary LF-patients (PLF) using a 1:5 weighted propensity score matching. The primary outcome was 1-year recurrence of symptoms (in patients with GERD) or radiological wrap slippage or HH recurrence in patients with HH. Secondary outcomes included the Gastrointestinal Quality of Life Index (GIQLI) and perioperative and postoperative data.

There were 31 RLF (6 GERD, 25 HH) and 120 (36 GERD, 84 HH) PLF cases. Symptomatic recurrence for GERD indication after 1 year was seen in 16.7% after RLF and 11.1% after PLF (p = 0.54). Radiological abnormalities in HH were seen in 36% after RLF (24% minor slippages and 12% recurrent hernias) and 15.5% after PLF (11.9% minor slippage and 3.6% recurrent hernias; p = 0.028). Operative time (188 min vs. 147 min, p < 0.001) and hospital stay (6.6 days vs. 3.8 days, p < 0.001) were significantly longer after RLF. Early complication rates were higher in RLF (16.1% vs. 3.3%, p = 0.007). GIQLI scores were comparable (122.6/144 after RLF vs. 124.4/144 after PLF, p = 0.58), with > 92% of patients in both groups reporting good/excellent outcomes.

RLF is associated with longer operative time, increased morbidity, and higher rates of CT abnormalities compared to PLF. Symptom control and quality of life were comparable.