Evaluation of Outcome of Laparoscopic Nissen Fundoplication with or without Fundophrenicopexia in Surgical Management of Hiatal Hernia.

Background

Gastroesophageal reflux disease (GERD) and hiatal hernia frequently coexist, impairing quality of life and often requiring surgical intervention. Laparoscopic Nissen fundoplication (LNF) is the gold standard, but recurrence, dysphagia, and gas-bloat remain concerns. FundophrenicopexiaFundophrenicopexia, fixation of the gastric fundus to the diaphragm, has been proposed to reinforce hiatal closure and reduce recurrence. This study prospectively compared LNF with and without fundophrenicopexia.

Methods

A prospective comparative study was conducted at Suez Canal University Hospitals (January 2025-January 2026). Forty patients with hiatal hernia were enrolled into two groups: LNF alone (n=20) and LNF with fundophrenicopexia (n=20). Primary endpoint was hernia recurrence, defined radiologically or endoscopically. Secondary endpoints included GERD-HRQL scores, operative parameters, complications, functional outcomes, and reoperation rates. Patients were followed with structured clinical and endoscopic assessments.

Results

Recurrence occurred in 15% of patients undergoing LNF alone versus 0% with fundophrenicopexia (p=0.04)during the follow-up period (11.2±1.8months). Logistic regression confirmed fundophrenicopexiafundophrenicopexia as an independent protective factor (OR=0.18, 95% CI: 0.02-0.95). Failures in the LNF group included wrap migration and disruption, while recurrence in the fundophrenicopexiafundophrenicopexia group was limited to partial herniation. Operative time was longer with fundophrenicopexiafundophrenicopexia (68.5 vs 52.3minutes, p=0.003), but blood loss and conversion rates were similar. Larger hernia size and higher BMI independently predicted recurrence. Quality of life outcomes favored fundophrenicopexiafundophrenicopexia, with lower GERD-HRQL scores (median 3 vs 6, p=0.042) and greater symptom improvement.

Conclusion

Fundophrenicopexia was associated with lower recurrence and improved patient‑reported outcomes without increasing dysphagia. This modification may enhance durability and quality of life, particularly in patients with large hernias or elevated BMI, and warrants further evaluation as a potential adjunct in routine hiatal hernia repair.