Medium-term efficacy of laparoscopic Dor fundoplication combined with the reconstruction of angle of His in the treatment of gastroesophageal reflux disease

Background Gastroesophageal reflux disease (GERD)is currently one of the most common digestive tract diseases. There is no report on laparoscopic fundoplication combined with reconstruction of angle of His (RAH) in the treatment of GERD. Thus, this study aimed to investigate the medium-term efficacy of laparoscopic Dor fundoplication combined with RAH for GERD patients. Methods Clinical data of GERD patients who underwent Dor fundoplication combined with RAH (Dor+RAH group, 116 cases) or Dor fundoplication (Dor group, 107 cases) in Department of General Surgery, Xuanwu Hospital, Capital Medical University from January 2019 to June 2022 were retrospectively analyzed. Esophageal and extraesophageal symptom scores, functional complications, and patient satisfaction were compared between the two groups after two years postoperatively. Results There was no significant difference in esophageal and extraesophageal symptom scores between the two groups before surgery (all P >0.05). At 2 years postoperatively, esophageal and extraesophageal symptom scores of both two groups decreased significantly compared with those preoperatively (all P <0.01). In the 2-year postoperative symptom scores, the scores for regurgitation and heartburn in the Dor+RAH group were lower than those in the Dor group, with statistically significant differences ( P <0.01, P =0.006), while there were no significant differences in other symptom scores between the two groups (all P >0.05). The incidences of postoperative functional complications (including dysphagia, abdominal distension, difficulty to belch, increased flatus, and chronic abdominal pain) were similar in both groups, and all were significantly relieved by conservative treatment. The patient satisfaction rate with surgical treatment was 92.2% (107/116) in the Dor+RAH group, showing no significant difference from 90.7% (97/107) in the Dor group ( P =0.671). Conclusions: Both Dor fundoplication combined with RAH and pure Dor fundoplication demonstrate good anti-reflux effects in treating GERD, with few surgical complications and high patient satisfaction. Compared with Dor fundoplication, Dor fundoplication with RAH has a better effect in controlling regurgitation and heartburn symptoms, indicating it may have a better therapeutic effect for GERD patients.