Laparoscopic fundoplication with or without intraoperative endoscopy for gastroesophageal reflux disease: a propensity score-matched cohort study

The aim of this study was to evaluate whether intraoperative endoscopic testing (IOET) improves clinical outcomes following antireflux surgery. We conducted a retrospective cohort study of all patients who underwent laparoscopic Nissen or Toupet fundoplication between June 2020 and May 2024. Patients were divided into the IOET group and the non-IOET group. Propensity score matching (PSM) was used to balance baseline clinical characteristics between groups. The primary outcome was postoperative dysphagia. Secondary outcomes included regurgitation, gas-bloat syndrome, length of hospital stay, total hospitalization costs, and postoperative proton pump inhibitor (PPI) use. A total of 141 patients were included, with 53 matched patients in each group after PSM. The incidence of postoperative dysphagia at 6 weeks was significantly lower in the IOET group than in the NIOET group. Subgroup analyses demonstrated that the benefit of IOET was most evident among patients undergoing Nissen fundoplication. However, total hospitalization costs were higher in the IOET group than in the NIOET group (22,973.39 ± 4953.04 vs. 18,928.35 ± 2745.79 RMB; P < 0.01). Operative time was also longer in the IOET group (114.28 ± 20.33 vs. 105.36 ± 18.22 min; P = 0.02). No significant differences were observed between the groups in length of hospital stay, postoperative PPI use, gas-bloat syndrome, or regurgitation at 6 weeks, 3 months, and 6 months. IOET was associated with a lower incidence of postoperative dysphagia at 6 weeks, particularly among patients undergoing Nissen fundoplication. Further studies are needed to validate these findings.