Abstract

Background: Hiatal hernia, a condition where a portion of the stomach prolapses through the diaphragmatic esophageal hiatus. Surgical interventions, including Toupet and Nissen fundoplication, are commonly employed to manage refractory GERD symptoms. Aim of the Study: This study aims to compare the efficacy of Toupet versus Nissen fundoplication in terms of reflux recurrence symptoms and patient satisfaction following hiatal hernia repair. Methodology: A retrospective cohort study was conducted at Iraqi Private Hospital from March 2021 to July 2023. The study included 206 patients with hiatal hernia and GERD who underwent laparoscopic hernia repair and fundoplication surgery. Patients were followed up for three years, and data were collected on demographic and clinical variables, symptom frequency, and severity using a Reflux Diagnostic Questionnaire (RDQ). Patient satisfaction and 24-hour esophageal pH monitoring were also assessed. Results: The study included 206 patients, with a mean age of 45.2 years. Among them, 54.4% underwent Nissen fundoplication, while 45.6% underwent Toupet fundoplication. Both surgical methods significantly reduced the frequency and severity of GERD-related symptoms. Nissen fundoplication showed better improvement in heartburn and regurgitation, while Toupet fundoplication resulted in better outcomes for dysphagia. Postoperative patient satisfaction was high for both procedures, with 51.8% of Nissen and 42.6% of Toupet patients reporting excellent satisfaction. Improvements in 24-hour pH monitoring parameters were significant in both groups, with Nissen showing slightly better results in some measures. Conclusions: Both Nissen and Toupet fundoplication are effective in reducing GERD symptoms and improving patient satisfaction after hiatal hernia repair. Nissen fundoplication offers better control of heartburn and regurgitation, while Toupet fundoplication is more beneficial for reducing postoperative dysphagia. Surgeons should consider individual patient characteristics and symptom profiles when selecting the appropriate surgical technique