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

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.
Competing Interests: Competing interests Dr. Abu Dayyeh is a consultant for Metamodix, BFKW, DyaMx, Boston Scientific, USGI medical, Hemostasis, and Endo-TAGSS. He has received research support from Apollo Endosurgery, USGI, Spatz Medical, Boston Scientific, GI Dynamics, Cairn Diagnostics, Aspire Bariatrics, and Medtronic. He has served as a speaker for Johnson & Johnson, EndoGastric Solutions, and Olympus. Dr. Janu is a consultant for EndoGastric Solutions, Ethicon/J&J, and Olympus. Dr. Murray is a consultant for Boston Scientific Corp, Pentax America. He has received research support from Pentax America. He has served as a speaker for AbbVie. He is an advisory board member for Colubris Rx. He has received royalties from UpToDate. Dr. Chang is a consultant for and has received educational research grants from EndoGastric Solutions, is a consultant for and has received educational grants from Cook and Olympus. Dr. Canto has received research support from EndoGastric Solutions and Pentax Medical Corporation and has received royalties from UpToDate.
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