Laparoscopic Fundoplication for Hiatal Hernia Gold Standard for The Management of Intractable Reflux Disease

Author(s): Vinod Kumar Singhal, Faris Al Aswad, Md Merajuddin, Raafat Samuel Fares, Adel Md Suleman, Nufra Senopher, Vidher VV Singhal

Background: Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the backflow of stomach contents into the esophagus, leading to symptoms like heartburn and regurgitation. Hiatal hernia, where stomach organs protrude through the diaphragm, increases GERD risk by disrupting esophageal acid clearance. The surgical management of GERD has advanced, with laparoscopic fundoplication now the preferred approach for intractable cases due to its minimally invasive nature, durability, and effectiveness in symptom relief. Studies confirm laparoscopic fundoplication as the gold standard for long-term GERD control and prevention of symptom recurrence.

Aim of the study: The study aims to evaluate the effectiveness and safety of laparoscopic fundoplication in treating intractable reflux disease caused by hiatal hernia.

Methods: This retrospective study analyzed 1,200 patients with intractable GERD secondary to hiatal hernia who underwent laparoscopic fundoplication over 15 years across multiple centers, including Prime Hospital, Dubai. Patients included were adults with persistent heartburn on proton pump inhibitors. Key data collected encompassed demographics, preoperative symptoms, operative details, and postoperative outcomes, with follow-ups at 1, 6, and 12 months. The surgical procedure entailed reducing the hiatal hernia, repairing the hiatus, and creating a new valve with the gastric fundus.

Result: The study population had a mean age of 47.2 years, showing a balanced gender distribution (52% male, 48% female) and an average BMI of 26.5 kg/m². Most participants (66.25%) had been on proton pump inhibitors for over a year. Heartburn (90.08%) was the most prevalent symptom, followed by regurgitation (85.17%). Postoperatively, laparoscopic fundoplication significantly reduced symptoms, with heartburn decreasing to 10% and regurgitation to 8%. Complications were minimal, with 10% experiencing symptom recurrence and 2% requiring reoperation. Patient satisfaction was high, with 85% reporting positive outcomes following the procedure.

Conclusion: Laparoscopic fundoplication is an effective surgical treatment for intractable GERD related to hiatal hernia, significantly reducing symptoms like heartburn and regurgitation. Patient satisfaction was high at 85%, with low complication rates (10% gas bloat syndrome, 15% dysphagia) and minimal recurrence (10%) and reoperation (2%) rates, affirming its gold standard status.