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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(01): E11-E18
DOI: 10.1055/a-1972-9190
Original article

Hiatal hernia repair with transoral incisionless fundoplication versus Nissen fundoplication for gastroesophageal reflux disease: A retrospective study

Veeravich K. Jaruvongvanich
 1   Mayo Clinic – Gastroenterology and Hepatology, Rochester, Minnesota, United States
,
Reem Matar
 1   Mayo Clinic – Gastroenterology and Hepatology, Rochester, Minnesota, United States
,
Janani Reisenauer
 2   Mayo Clinic – Thoracic Surgery, Rochester, Minnesota, United States
,
Peter Janu
 3   Fox Valley Technical College, ThedaCare Regional Medical System, Appleton, Wisconsin, United States
,
Peter Mavrelis
 4   Methodist Hospitals Inc. – Surgery, Gary, Indiana, United States
,
Glenn Ihde
 5   Matagorda Regional Medical Center – Matagorda Medical Group, Bay City, Texas, United States
,
Michael Murray
 6   UNRMed – University of Nevada, Reno, Nevada, United States
,
Sneha Singh
 1   Mayo Clinic – Gastroenterology and Hepatology, Rochester, Minnesota, United States
,
Jennifer Kolb
 7   UCIrvine – Gastroenterology, Irvine, California, United States
,
Ninh T. Nguyen
 8   UCIrvine – Surgery, Irvine, California, United States
,
Nirav Thosani
 9   University of Texas McGovern Medical School – Gastroenterology, Hepatology and Nutrition, Houston, Texas, United States
,
Erik B. Wilson
10   University of Texas McGovern Medical School – Surgery, Houston, Texas, United States
,
Rasa Zarnegar
11   Weill Cornell Medical College – Surgery, New York, New York, United States
,
Kenneth Chang
 7   UCIrvine – Gastroenterology, Irvine, California, United States
,
Marcia I. Canto
12   Johns Hopkins Hospital and Health System – Gastroenterology, Baltimore, Maryland, United States
,
Barham K. Abu Dayyeh
 1   Mayo Clinic – Gastroenterology and Hepatology, Rochester, Minnesota, United States
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Abstract

Background and study aims Concomitant hiatal hernia (HH) repair with transoral incisionless fundoplication (TIF) is a therapeutic option for patients with HH > 2 cm and gastroesophageal reflux disease (GERD). Data comparing this approach with laparoscopic Nissen fundoplication (LNF) are lacking. We performed an exploratory analysis to compare these two approaches' adverse events (AEs) and clinical outcomes.

Patients and methods This was a multicenter retrospective cohort study of HH repair followed by LNF versus HH repair followed by TIF in patients with GERD and moderate HH (2–5 cm). AEs were assessed using the Clavien-Dindo classification. Symptoms (heartburn/regurgitation, bloating, and dysphagia) were compared at 6 and 12 months.

Results A total of 125 patients with HH repair with TIF and 70 with HH repair with LNF were compared. There was no difference in rates of discontinuing or decreasing proton pump inhibitor use, dysphagia, esophagitis, disrupted wrap, and HH recurrence between the two groups (P > 0.05). The length of hospital stay (1 day vs. 2 days), 30-day readmission rate (0 vs. 4.3 %), early AE rate (0 vs. 18.6 %), and early serious AE rate (0 vs. 4.3 %) favored TIF (all P < 0.05). The rate of new or worse than baseline bloating was lower in the TIF group at 6 months (13.8 % vs. 30.0 %, P = 0.009).

Conclusions Concomitant HH repair with TIF is feasible and associated with lower early and serious AEs compared to LNF. Further comparative efficacy studies are warranted.



Publication History

Received: 24 March 2022

Accepted after revision: 19 October 2022

Article published online:
04 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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