Comparison of laparoscopic Nissen and Dor fundoplication for gastroesophageal reflux disease and paraesophageal hernia: A case-control study

Abstract Purpose This case-control study aims to compare the different safety and efficacy of laparoscopic Nissen (LNF) and Dor (LDF) fundoplication totally from a patient-subjective view. Methods One hundred patients receiving laparoscopic anti-reflux surgery (LARS), either LNF or LDF to manage clinically diagnosed GERD & PEH between January 2018 and December 2021 were recruited. Patient outcomes were evaluated at the three-month follow up visit using GERD symptom questionnaire (GERD-Q), a dysphagia Likert scale, and GERD-Health Related Quality of Life (GERD-HRQL) questionnaire. Results Seventy-nine patients met the selection criteria. Twenty-one underwent LNF and fifty-eight received LDF. There was no significant difference in age, gender, preoperative BMI, surgical duration, bleeding volume, meshes replacement and postoperative hospital stays between these two groups (P > 0.05). The relief of GERD symptoms were achieved in patients receiving either LNF or LDF. Although LNF appeared to be better in controlling nausea, patients treated with LNF was more likely to suffer postoperative dysphagia than those receiving LDF (P = 0.035). Interestingly, HRQL assessment suggested that a higher percentage of LNF patients were unsatisfied with the treatment outcome relative to the LDF group, although the difference was marginal (28.57% versus 5.17%, P = 0.096). Conclusion Our patient-oriented comparisons suggested that LNF and LDF were both effective and safe for managing GERD & PEH. LNF appeared to cause less nausea in patients, while LDF was associated with fewer severe postoperative dysphagia cases and higher satisfaction of patients.