Postoperative Dysphagia and Short-term Outcomes Following Laparoscopic Floppy Nissen Fundoplication Combined with V-flap Suturing

Objective To compare postoperative dysphagia and anti-reflux efficacy between laparoscopic floppy Nissen fundoplication with V-flap suturing (LNF-V) and conventional laparoscopic Nissen fundoplication (LNF). Methods This retrospective cohort study included patients with gastroesophageal reflux disease (GERD) who underwent LNF-V or LNF between January 2022 and January 2024 at the Department of General Surgery of Xuanwu Hospital, Xiong an Xuanwu Hospital, and Beijing Feng tai Hospital of Traditional Chinese Medicine. After applying inclusion and exclusion criteria, 173 patients were enrolled, including 113 in the LNF-V group and 60 in the LNF group. In the LNF-V procedure, following the standard 360° fundoplication, the wrap was further sutured to the left and right diaphragmatic crura to form a V-shaped configuration. Saeed dysphagia scores and Gerd-Q scores were assessed preoperatively and at 3, 6, and 12 months postoperatively. Operative time, intraoperative blood loss, hospital stay, and postoperative complications were also recorded. Results There were no significant differences between the two groups in baseline characteristics including sex, age, BMI, symptom duration, lower esophageal sphincter (LES) pressure, and DeMeester score (P > 0.05). Intraoperative blood loss and hospital stay were also similar. The operative time was slightly longer in the LNF-V group than in the LNF group (P < 0.001). Regarding dysphagia, Saeed scores were significantly lower in the LNF-V group at 3 to 6 months postoperatively (P < 0.001), indicating better recovery of swallowing function; by 12 months, scores were comparable between the groups (P = 0.785). Gerd-Q scores at 3 months were significantly lower in the LNF-V group (P = 0.008), reflecting better reflux symptom control, while no significant differences were observed at 6 and 12 months (P = 0.078 and 0.541, respectively). Conclusion Compared with conventional LNF, the LNF-V technique offers better early postoperative improvement in dysphagia and reflux symptoms, with comparable long-term efficacy. It is a safe and feasible surgical option with promising clinical applicability.