Comparative analysis between total and partial laparoscopic fundoplication after paraoesophageal hernia repair

The management of paraoesophageal hernia has been a subject to significant debate, particularly regarding the timing and approach of surgical intervention. Objective — to compare postoperative outcomes between Nissen and Dor fundoplication techniques for treating paraoesophageal hernias. Materials and methods. A prospective study was conducted at the Ivano‑Frankivsk Regional Hospital from March 2018 to January 2023, involving 106 patients undergoing either Nissen or Dor fundoplication. Inclusion criteria were patients 18 years or older with paraoesophageal hernias requiring surgery. Exclusions were previous esophageal or gastric surgery, esophageal motility disorders, or contraindications to general anesthesia or laparoscopic surgery. Follow¬up assessments were conducted at 1 and 3 months post‑surgery and included dysphagia rate, need for proton pump inhibitors, comorbidity profiles, duration of surgery, and hospital stay. Results. Both groups were comparable in terms of age, gender, body mass index, and preoperative symptoms, ensuring a fair comparison of surgical outcomes. The Nissen procedure showed a trend towards longer operative times and hospitalization duration, which could be attributed to its technical complexity. The Dor fundoplication group exhibited a more significant reduction in dysphagia symptoms postoperatively. This finding suggests better management of this specific complication compared to the Nissen group. A notable decrease in the need for proton pump inhibitors was observed in the Dor group, indicating more effective control of acid reflux symptoms. Conclusions. Dor fundoplication is associated with less severe postoperative dysphagia and reduced need for proton pump inhibitors compared to Nissen fundoplication. Additionally, Nissen fundoplication tends to involve longer operation times and hospital stays, indicating higher complexity. The study highlights the impact of fundoplication type on postoperative outcomes in paraoesophageal hernia patients.