What question did this study set out to answer?

This research aims to evaluate the safety and effectiveness of symmetrical anterior–posterior partial fundoplication for GERD.

June 21, 2026Open Access

Symmetrical anterior–posterior partial fundoplication: technique and outcomes

Key Points

This research aims to evaluate the safety and effectiveness of symmetrical anterior–posterior partial fundoplication for GERD.
Retrospective review of 355 patients who underwent elective antireflux surgery from September 2016 to December 2024.
Exclusion of non-primary and emergency procedures, with a focus on perioperative complications and patient-reported outcomes.
Follow-up included assessments of hiatal hernia recurrence and patient satisfaction for up to 7 years.
Severe complications occurred in 3 patients (0.8%), with no 90-day mortality reported.
Median GERD-HRQL scores improved significantly from 32 preoperatively to 1 after one year and remained low over seven years.
Hiatal hernia recurrence was observed in 22 patients over the follow-up period, indicating continued efficacy of the procedure.

Abstract

Abstract Background Partial fundoplication is the most common surgical treatment for gastroesophageal reflux disease (GERD). Our preferred technique is a symmetrical anterior–posterior partial (300°) fundoplication created along the natural axis of the stomach, leaving the bare area on the esophagus along the lesser curvature. We assessed perioperative and long-term outcomes of this technique. Methods We retrospectively reviewed records of all patients who underwent primary elective antireflux surgery by a single foregut surgeon from September 2016 to December 2024. Non-primary and emergency procedures and other techniques (such as Dor) were excluded. Perioperative complications, hiatal hernia recurrence, patient-reported outcomes (PROMs), and patient satisfaction were assessed for up to 7 years. Results We identified 355 patients (254 71.5% women; median age, 64 years) who underwent primary antireflux surgery (laparoscopic 79.2%, robotic 20.6%, and conversion 0.3%). The median operative time, estimated blood loss, and length of stay were 90 min (IQR 70–110), 25 mL (IQR 10–25), and 1 day (IQR 1–2). Severe complications (Clavien–Dindo grade ≥ III) occurred in 3 (0.8%) patients. There was no 90-day mortality. GERD health-related quality of life (GERD-HRQL) questionnaires and/or objective assessment using barium esophagram or upper GI endoscopy were completed by 222/355 (62.5%), 134/322 (41.6%), 56/267 (21.0%), 43/166 (25.9%), and 19/90 (21.1%) patients at 1, 2, 3, 5, and 7 years, respectively. The median total GERD-HRQL scores improved from 32 (IQR 13–46) preoperatively to 1 (IQR 0–4), 2 (IQR 0–7), 2 (IQR 0–12), 1 (IQR 0–6), and 5 (IQR 1–24) at 1, 2, 3, 5, and 7 years, respectively. Over 7 years, objective HH recurrence occurred in 22 patients (≥ 2 cm in 5 patients). Conclusions Symmetrical anterior–posterior partial fundoplication is safe and effective, providing sustainable relief from GERD symptoms with high patient satisfaction reported up to 7 years. Interpretation of these promising results is limited by the small number of patients with extended follow-up.

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