Comparing Nissen, Toupet, Dor, His reconstruction, and W–H fundoplication: real-world 1-year outcomes of five laparoscopic antireflux procedures

BACKGROUND: Gastroesophageal reflux disease (GERD) is a global health burden, and the optimal choice among various laparoscopic antireflux procedures remains debated. We compared the effectiveness of five surgical techniques-Nissen, Toupet, Dor, His angle reconstruction, and W-H fundoplication-over a 1-year postoperative period. MATERIALS: In this single-center retrospective cohort (January 2016-May 2024), 359 GERD patients underwent one of the five laparoscopic procedures. Total symptom score, SF-36 PCS/MCS, GERD-HRQL, and EAT-10 were assessed longitudinally. Longitudinal trajectories were analyzed using linear mixed-effects models with estimated marginal means. Multivariable (Firth) logistic regression was used to identify the predictors of 1-year symptom recurrence and persistent PPI dependence. RESULTS: All five procedures were associated with sustained symptom improvement and significant gains in physical and mental quality of life over 1 year. Early postoperative dysphagia differed among procedures-most pronounced after Nissen-but converged by 6 to 12 months, with near-normal EAT-10 scores across groups at 1 year. No clinically meaningful between-procedure differences were observed in patient-reported outcomes at 1 year. Preoperative symptom severity was the only independent predictor of symptom recurrence (OR = 1.13 per point increase; P < 0.001), whereas surgical type was not associated with symptom recurrence or PPI dependence after adjustment. CONCLUSIONS: These five laparoscopic antireflux procedures were associated with substantial improvement in patient-reported symptoms and quality of life at 1 year. Early postoperative dysphagia differed among procedures but largely resolved over time. Mid-term outcomes appear to depend more on baseline symptom burden and phenotype-informed procedure selection than on adherence to a single universal "gold standard" technique.