Concomitant Transoral Incisionless Fundoplication Compared to Surgical Hiatal Hernia Repair: Early Outcomes and Novel Analysis of Patients with Significant Pulmonary Comorbidities

Background: Surgical hiatal hernia (HH) repair with concomitant transoral incisionless fundoplication (cTIF) is a combined surgical-endoscopic procedure. Comparative studies between cTIF and conventional HH repair surgeries are limited. This study evaluated the early postoperative outcomes of cTIF compared to surgical HH repair, with subgroup analysis of patients with pulmonary comorbidities. Methods: A single-center, retrospective cohort study was conducted on adult patients undergoing HH repair between December 2019 and April 2026. Outcomes were compared between cTIF and surgical HH repair. Results: Among 124 patients, 77 underwent cTIF and 47 surgical HH repairs. Baseline characteristics were similar, although the surgical HH repair group had more cardiovascular and metabolic comorbidities ( P < .05). In the subgroup of patients with pulmonary comorbidities, in the cTIF group, patients had more preoperative cough (75.0% vs 20.0%, P < .01), and less blood loss (27.4 ± 13.0 vs 41.7 ± 31.0 mL, P = .02). Overall, cTIF was associated with a shorter operative time (140 vs 161 minutes) and lower blood loss (26.2 ± 9.3 vs 37.0 ± 27.3), both P < .05, and lower rate of 30-day complications (2.6% vs 12.8%, P = .05). Conclusion: cTIF is a feasible and safe alternative to surgical HH repair, associated with shorter operative time and less blood loss. The comparable outcomes observed in patients with pulmonary comorbidities highlight the procedural tolerability of cTIF and support its use in higher risk populations.