ArticleSurgical endoscopy2026
Symmetrical anterior-posterior partial fundoplication: technique and outcomes.
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
backgroundPartial fundoplication is the most common surgical treatment for gastroesophageal reflux disease (GERD). Our preferred technique is a symmetrical anterior-posterior partial (300°) fundoplication created along the natural axis of the stomach, leaving the bare area on the esophagus along the lesser curvature. We assessed perioperative and long-term outcomes of this technique.
methodsWe retrospectively reviewed records of all patients who underwent primary elective antireflux surgery by a single foregut surgeon from September 2016 to December 2024. Non-primary and emergency procedures and other techniques (such as Dor) were excluded. Perioperative complications, hiatal hernia recurrence, patient-reported outcomes (PROMs), and patient satisfaction were assessed for up to 7 years.
resultsWe identified 355 patients (254 [71.5%] women; median age, 64 years) who underwent primary antireflux surgery (laparoscopic [79.2%], robotic [20.6%], and conversion [0.3%]). The median operative time, estimated blood loss, and length of stay were 90 min (IQR 70-110), 25 mL (IQR 10-25), and 1 day (IQR 1-2). Severe complications (Clavien-Dindo grade ≥ III) occurred in 3 (0.8%) patients. There was no 90-day mortality. GERD health-related quality of life (GERD-HRQL) questionnaires and/or objective assessment using barium esophagram or upper GI endoscopy were completed by 222/355 (62.5%), 134/322 (41.6%), 56/267 (21.0%), 43/166 (25.9%), and 19/90 (21.1%) patients at 1, 2, 3, 5, and 7 years, respectively. The median total GERD-HRQL scores improved from 32 (IQR 13-46) preoperatively to 1 (IQR 0-4), 2 (IQR 0-7), 2 (IQR 0-12), 1 (IQR 0-6), and 5 (IQR 1-24) at 1, 2, 3, 5, and 7 years, respectively. Over 7 years, objective HH recurrence occurred in 22 patients (≥ 2 cm in 5 patients).
conclusionsSymmetrical anterior-posterior partial fundoplication is safe and effective, providing sustainable relief from GERD symptoms with high patient satisfaction reported up to 7 years. Interpretation of these promising results is limited by the small number of patients with extended follow-up.
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