Society for Surgery of the Alimentary Tract
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Vanessa N. VanDruff*1,2, Julia R. Amundson1, Stephanie Joseph3,2, Simon Che2, Christopher J. Zimmermann2, Shun Ishii2, Kristine Kuchta2, Herbert M. Hedberg2, Michael Ujiki2
1General Surgery, University of Chicago Division of the Biological Sciences, Chicago, IL; 2NorthShore University HealthSystem, Evanston, IL; 3Wayne State University, Detroit, MI

Toupet fundoplication (TF) has been shown to have fewer adverse effects compared to Nissen fundoplication (NF), however, it is unknown whether the advantages of TF persist when comparing outcomes by the distensibility of post-fundoplication lower esophageal sphincter (LES). Therefore, we aimed to compare quality of life (QOL) outcomes between NF and TF according to distensibility index (DI) measured by intraoperative endoluminal impedance planimetry.

This is a retrospective study of a prospectively maintained database of patients who underwent laparoscopic NF or TF, intraoperative EndoFLIP, and self-reported QOL outcomes postoperatively at 3-weeks, 6-months, 1-year, and 2-years using RSI, GERD-HQRL, and dysphagia surveys. Comparisons were made using chi-square and Wilcoxon rank-sum tests.

From 2018 to 2021, 303 patients were analyzed (68% female) who underwent NF (n=80) and or TF (n= 223) for treatment of GERD, including paraesophageal hernia which represented 65% of cases. Of those who returned postoperative surveys, at 30mL fill-volumes, there were a total of 20 NF versus 25 TF with DI <2.0mm2/mmHg, 32 NF versus 71 TF with DI 2.0-3.5mm2/mmHg, and 13 NF versus 89 TF with DI>3.5 mm2/mmHg. At the optimal DI range of 2.0-3.5 mm2/mmHg at 30mL fill, no statistical differences were found on analysis at 3-weeks, 6-months, 1-year, and 2-year timepoints when evaluating RSI, GERD HQRL, gasbloat, and dysphagia scores. No statistical differences were found on QOL comparisons of NF versus TF within DI ranges <2.0mm2/mmHg or DI> 3.5mm2/mmHg at any timepoint (Table 1). At 40ml fill volume, there was a total of 20 NF versus 25 TF at DI < 2.0mm2/mmHg, 32 NF versus 71 TF with DI 2.0-3.5 mm2/mmHg, and 13 NF versus 89 TF at DI >3.5 mm2/mmHg. Analysis of postoperative surveys demonstrated no statistical differences when comparing RSI, GERD-HQRL, gasbloat and dysphagia scores of NF versus TF according to DI range <2.0mm2/mmHg, 2.0-3.5mm2/mmHg (Figure 1), or >3.5mm2/mmHg at any postoperative timepoint.

Impedance planimetry appears to be an objective measure of the physiology of the LES before, during, and after fundoplication. NF is comparable to TF when compared according to DI range, suggesting that QOL outcomes are dependent on post-fundoplication LES distensibility rather than type of fundoplication.

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