S2220 Evaluating the Mid-Term Efficacy of Consecutive Hiatal Hernia Repair With Transoral Incisionless Fundoplication for Gastroesophageal Reflux Disease: A Meta-Analysis With 1-Year Follow-Up

Introduction: Consecutive hiatal hernia (HH) repair with transoral incisionless fundoplication (cTIF) is an appealing treatment option for refractory gastroesophageal reflux disease (GERD) with a favorable side effect profile compared to the tradition Nissen fundoplication. This meta-analysis aimed to evaluate the mid-term outcomes of cTIF in adult patients with GERD, specifically those with hiatal hernias >2 cm, who have demonstrated refractoriness to medical therapy. Methods: A systematic search of PubMed and Embase was conducted up to May 15, 2025. The principal outcome measures, assessed following a minimum 12-month follow-up period, were the GERD-HRQL (Health-Related Quality of Life), RSI (Reflux Symptom Index), and GERSS (Gastroesophageal Reflux Symptom Score) questionnaires. Secondary outcomes included technical success rate, incidence of adverse events, patient satisfaction rate (PSR), and rate of proton pump inhibitors (PPI) discontinuation. A random-effects model was used to calculate the standardized mean difference (SMD) and odds ratio (OR), with statistical significance defined as P < 0.05. Data analysis was performed using RevMan and MedCalc software. Results: A total of 6 studies were included, enrolling 602 patients with 494 individuals undergoing cTIF. The mean age of the study population was 58 ± 3.73 years, with a mean BMI of 29 ± 2.2 and a mean HH length of 3.5 ± 0.65 cm. The average follow-up duration was 12.28 ± 2.47 months. Pooled analysis indicated a technical success rate of 100% for cTIF, with an adverse event rate of 4.1%. At 12 months, 75.5% of the patients had ceased PPI use, and the PSR was 76.58%. We detected statistically significant improvements in GERD-HRQL (SMD 4.01, 95% CI 2.35 to 5.67, I2 = 92%), RSI (SMD 2.31, 95% CI 1.69 to 2.92, I2 = 87%), and GERSS (SMD 1.59, 95% CI 1.31 to 1.87, I2 = 0%) following cTIF Although 2 studies comparing cTIF with surgery alone at 12 months suggested a trend towards increased PPI cessation in the cTIF group (OR 1.69, P = 0.09, I2 = 0%), this difference was not statistically significant. Conclusion: cTIF is technically feasible and demonstrates promising outcomes, as evidenced by significant improvements in mid-term GERD-related scores. Additional well-designed comparative studies across multiple centers are required to validate these observations.