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Nissen versus Toupet fundoplication quality-of-life outcomes compared by intraoperative EndoFLIP™ distensibility
Vanessa N VanDruff1,2, Colin Y Wang3,4, Julia R Amundson4
1Department of Minimally Invasive Surgery, Endeavor Health, 2650 Ridge, Avenue, GCSI Suite B665, Evanston, IL, 60201, USA. Vanessa.vandruff@uchospitals.edu.
Introduction:
Studies have demonstrated that Toupet fundoplications (TF) result in equitable reflux control with improved outcomes of gas-bloat compared to Nissen fundoplications (NF). Currently, it is unknown if the advantages of TF remain significant compared to NF of similar gastroesophageal junction distensibility post-fundoplication. This study aims to compare TF and NF quality-of-life (QOL) outcomes according to intraoperative endoluminal impedance planimetry (EndoFLIP) distensibility index (DI).
Methods:
A retrospective study was performed on a database of patients who received laparoscopic TF or NF with intraoperative EndoFLIP. Patients reported QOL using gastroesophageal reflux disease-health-related quality-of-life questionnaire (GERD-HRQL), reflux symptom index (RSI), gas-bloat score, and dysphagia surveys pre- and postoperatively at 3 weeks, 6 months, 1 year, and 2 years. Statistical analysis was conducted using Wilcoxon rank-sum and chi-square tests.
Results:
509 patients received TF (n = 429) or NF (n = 80) between 2018 and 2024 for GERD. Paraesophageal hernias represented 81% of cases. Intraoperatively. 315 patients received DI measurement at 30 ml fill-volume, (NF n = 65 vs. TF n = 250). 441 patients received measurements at 40 mL fill (NF n = 43 vs. TF n = 398). Average post-fundoplication DI at 30 ml was lower after NF with DI 2.6 ± 1.2 mm2/mmHg vs TF DI of 3.3 ± 1.5 mm2/mmHg (p < 0.001), but was not statistically different at 40 ml volume (NF 3.5 ± 1.3 vs. TF 3.2 ± 1.3). QOL surveys from patients with DI range < 2.0 mm2/mmHg demonstrated no significant differences in QOL at 3-week, 6-month, or 1-year timepoints. DI at 2.0-3.5 mm2/mmHg and > 3.5mm2/mmHg demonstrated no differences on GERD-HRQL, RSI, gas-bloat, or dysphagia scores at any time point.
Conclusion:
EndoFLIP can be used for objective measures of LES physiology after fundoplication. When compared by DI range, QOL of NF vs. TG are comparable, suggesting outcomes are dependent on post-fundoplication distensibility rather than type of fundoplication.
