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Introduction <p>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&#xa0;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).</p> Methods <p>A retrospective study was performed on a&#xa0;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.</p> Results <p>509 patients received TF (<i>n</i> = 429) or NF (<i>n</i> = 80) between 2018 and 2024 for GERD. Paraesophageal hernias represented&#xa0;81% of cases. Intraoperatively.&#xa0;315 patients&#xa0;received&#xa0;DI measurement at 30&#xa0;ml fill-volume, (NF <i>n</i> = 65 vs. TF <i>n</i> = 250). 441 patients received measurements&#xa0;at 40&#xa0;mL fill (NF <i>n</i> = 43 vs. TF <i>n</i> = 398). Average post-fundoplication DI at 30&#xa0;ml was lower after NF with DI 2.6 ± 1.2 mm<sup>2</sup>/mmHg vs TF DI of 3.3 ± 1.5 mm<sup>2</sup>/mmHg (<i>p</i> &lt; 0.001), but was not statistically different at 40&#xa0;ml volume&#xa0;(NF 3.5 ± 1.3 vs. TF 3.2 ± 1.3). QOL surveys from patients with DI range &lt; 2.0 mm<sup>2</sup>/mmHg demonstrated no significant differences in QOL at 3-week, 6-month, or 1-year timepoints. DI at 2.0–3.5 mm<sup>2</sup>/mmHg and &gt; 3.5mm<sup>2</sup>/mmHg demonstrated no differences on GERD-HRQL, RSI, gas-bloat, or dysphagia scores at any time point.</p> Conclusion <p>EndoFLIP can be used for objective measures of LES physiology&#xa0;after fundoplication. When compared by&#xa0;DI range, QOL of NF vs. TG are comparable,&#xa0;suggesting outcomes are dependent on post-fundoplication distensibility rather than type of fundoplication.</p>

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Nissen versus Toupet fundoplication quality-of-life outcomes compared by intraoperative EndoFLIP™ distensibility index range

  • 期刊论文

  • 发表日期：

    2026年6月20日

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  • Vanessa N. VanDruff,
  • Colin Y. Wang,
  • Julia R. Amundson,
  • Kristine Kuchta,
  • Herbert Mason Hedberg,
  • Michael B. Ujiki

摘要

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.