Short-Term Outcomes of Laparoscopic Hiatal Hernia Repair with Consecutive Transoral Incisionless Fundoplication: A Prospective Multicenter Cohort Study.

Abstract

Laparoscopic hiatal hernia repair with consecutive transoral incisionless fundoplication (cTIF) offers a combined endoscopic surgical therapy for gastroesophageal reflux disease (GERD), but data integrating symptom response with objective physiologic outcomes remain limited. Prospective multicenter registry of patients with BMI <35 kg/m², hiatal hernia <5 cm, confirmed GERD, and no prior anti-reflux intervention undergoing cTIF across 8 sites. The primary endpoint was clinical success, defined as >50% reduction in GERD-Health Related Quality of Life (GERD-HRQL) score within 12 months. Secondary endpoints included reflux symptom index (RSI) normalization, esophageal acid exposure normalization by pH testing or discontinued/rare proton pump inhibitor (PPI) use, patient satisfaction, and adverse events. Among 188 patients (mean hiatal hernia 3 cm), clinical success was achieved in 92%. GERD-HRQL improvement occurred in 90%, and RSI normalized in 84%. Daily PPI use was discontinued in 84%. Objective testing demonstrated normalization of esophageal acid exposure in 84% and DeMeester score in 85%. Patient satisfaction increased from 6% preoperatively to 75% postoperatively. Median length of stay was 23 hours [IQR 16-25]. Three serious adverse events occurred (1.6%). cTIF achieves high rates of symptom improvement, PPI discontinuation, and normalization of esophageal acid exposure with low morbidity, supporting its role as an effective strategy for selected patients with GERD.