ArticleSurgical endoscopy2026
Comparing Nissen, Toupet, Dor, His reconstruction, and W-H fundoplication: real-world 1-year outcomes of five laparoscopic antireflux procedures.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGastroesophageal reflux disease (GERD) is a global health burden, and the optimal choice among various laparoscopic antireflux procedures remains debated. We compared the effectiveness of five surgical techniques-Nissen, Toupet, Dor, His angle reconstruction, and W-H fundoplication-over a 1-year postoperative period. MATERIALS: In this single-center retrospective cohort (January 2016-May 2024), 359 GERD patients underwent one of the five laparoscopic procedures. Total symptom score, SF-36 PCS/MCS, GERD-HRQL, and EAT-10 were assessed longitudinally. Longitudinal trajectories were analyzed using linear mixed-effects models with estimated marginal means. Multivariable (Firth) logistic regression was used to identify the predictors of 1-year symptom recurrence and persistent PPI dependence.
resultsAll five procedures were associated with sustained symptom improvement and significant gains in physical and mental quality of life over 1 year. Early postoperative dysphagia differed among procedures-most pronounced after Nissen-but converged by 6 to 12 months, with near-normal EAT-10 scores across groups at 1 year. No clinically meaningful between-procedure differences were observed in patient-reported outcomes at 1 year. Preoperative symptom severity was the only independent predictor of symptom recurrence (OR = 1.13 per point increase; P < 0.001), whereas surgical type was not associated with symptom recurrence or PPI dependence after adjustment.
conclusionsThese five laparoscopic antireflux procedures were associated with substantial improvement in patient-reported symptoms and quality of life at 1 year. Early postoperative dysphagia differed among procedures but largely resolved over time. Mid-term outcomes appear to depend more on baseline symptom burden and phenotype-informed procedure selection than on adherence to a single universal "gold standard" technique.
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