[Efficacy of hiatal hernia repair combined with W-H fundoplication and gastric fixation in the treatment of...

Objective: To evaluate the safety and efficacy of a combined surgical procedure, namely laparoscopic hiatal hernia repair, W-H fundoplication combined with posterior fixation of the gastroesophageal junction, for refractory gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG). Methods: This was a retrospective observational study. The surgical indications and inclusion criteria were as follows: (1) aged over 18 years; (2) presence of obvious GERD symptoms such as reflux (acid regurgitation or rumination) and heartburn for more than 1 year, with maintenance treatment relying on acid-suppressive drugs such as proton pump inhibitors (PPIs) for more than 6 months; (3) inability to discontinue acid-suppressive drugs after long-term maintenance treatment, or incomplete control of GERD symptoms with long-term acid-suppressive drug treatment; (4) definite hiatal hernia confirmed by gastroscopy and pathological acid reflux detected by 24-hour pH-impedance monitoring within half a year. According to the above criteria, a total of 15 patients with gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) who underwent laparoscopic anti-reflux surgery at the Center for Gastroesophageal Reflux Disease, Rocket Force Characteristic Medical Center between January 2019 and September 2024 were enrolled. Among them, there were 4 males and 11 females, with a median age of 36 years (range: 24-66 years). All patients underwent laparoscopic hiatal hernia repair, W-H fundoplication combined with posterior fixation of the gastroesophageal junction, and telephone questionnaire follow-up was performed in October 2025 after surgery. The primary observation indicators were pre- and postoperative GERD symptom scores, PPI use, patient satisfaction, etc. Results: All 15 patients successfully completed the operation. The postoperative follow-up period was 20 (13-70) months. Scores of all GERD symptoms (acid regurgitation, heartburn, etc.) were significantly lower than those before surgery (all P<0.05). There was 1 case of mild recurrence, and the overall subjective relief rate of symptoms was 95% (40% -100%). Postoperatively, 10 out of 15 patients completely discontinued PPI, and 4 out of 15 patients reduced their medication dosage by more than half. Both the overall satisfaction rate and effective rate were 14/15. The incidence of postoperative complications was 3/15, mainly manifested as self-limiting dysphagia, which was relieved within 2-3 months after surgery. Conclusion: For refractory GERD after SG, the combined surgical procedure of hiatal hernia repair, W-H fundoplication combined with posterior fixation of the gastroesophageal junction can relieve symptoms, with good safety and mild postoperative complications.