Clinical Outcomes of 3D Laparoscopic Hiatal Hernia Repair Either Combined With Toupet Fundoplication or Nissen Fundoplication: A Comparative Analysis

Abstract

AIM: This study aimed to perform a rigorous comparison of perioperative and functional outcomes between the 3D laparoscopic Toupet (270° posterior partial fundoplication) vs. Nissen (360° total fundoplication) for hiatal hernia (HH) repair in gastroesophageal reflux disease (GERD) patients. METHODS: This retrospective cohort study included 103 patients with HH and GERD who underwent surgery between January 2020 and May 2024. Patients were divided into two groups based on surgical technique: the Toupet group (n = 53) and the Nissen group (n = 50). Outcomes included surgical metrics, pre/postoperative high-resolution manometry, 24-hour pH-impedance, gastroesophageal reflux disease symptom questionnaire (GERD-Q) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and complications. Multivariable regression adjusted for baseline differences. RESULTS: The Toupet group demonstrated significantly shorter time to first postoperative oral intake (p = 0.012) and hospital stays (p = 0.023) compared to the Nissen group. At 6 months postoperatively, both groups showed significant increases in minimum lower esophageal sphincter (LES) resting pressure and respiratory mean values, along with decreases in reflux-related parameters and ineffective swallowing ratio (p < 0.001). Intergroup comparison revealed that the Toupet group had lower minimum LES resting pressure, respiratory mean LES pressure, and ineffective swallowing ratio, but higher 24-hour reflux episodes, percentage acid exposure time, and mean DeMeester scores than the Nissen group (p < 0.001). At 1 year postoperatively, both groups exhibited significant improvements in GERD-Q and GERD-HRQL scores (p < 0.001), with no intergroup differences observed (p > 0.05). The Toupet group had significantly lower overall complication rates (p = 0.031) and a lower incidence of dysphagia than the Nissen group (p = 0.019). Multivariable regression analyses confirmed that the Toupet procedure was an independent predictor for shorter time to first postoperative oral intake (p = 0.015), shorter hospital stays (p = 0.017), and lower overall complication rates (p = 0.020). CONCLUSIONS: In summary, when performed with 3D laparoscopy, Toupet and Nissen fundoplication show distinct and meaningful clinical profiles. Nissen fundoplication is the preferred option for achieving maximal anti-reflux efficacy in patients with normal esophageal motility, whereas Toupet fundoplication is preferred for minimizing postoperative dysphagia and enhancing rapid recovery, particularly in cases with impaired or borderline motility.

Affiliated Institutions

• Jinhua Central Hospital CN

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