Evaluation of factors associated with reflux recurrence after fundoplication

Introduction: Reflux recurrence after fundoplication remains poorly understood, prompting an investigation into factors associated with it.

Methods: A study was conducted to review patients who had primary fundoplication. The main focus was on identifying recurrent reflux confirmed by an abnormal DeMeester score of > 14.7. Risk factors were evaluated using multivariable logistic regression. Additionally, Impedance planimetry (EndoFLIP™) measurements were taken into account if performed during the operation.

Results: Out of 137 patients who met inclusion criteria. 17 (12.4%) patients developed recurrent reflux, with 6.5% of them required secondary fundoplication. There were no significant differences in demographic, pre-operative or intra-operative characteristics between patients who developed recurrent reflux and those who did not (p > 0.05). However, in the subset of patients who underwent EndoFLIP™ monitoring during surgery (60%); patients who developed recurrent reflux had lower HPZ values post-wrap compared to those who did not [3.5 IQR (3-4) vs 2.5 IQR (1.8-3), p < 0.01]. Patient factors such as age, sex, BMI, and race were not found to be associated with recurrent reflux or reflux requiring surgical re-intervention in our analysis. However, having a low HPZ post-wrap was identified as a risk factor for recurrent reflux [0.15 95% CI (0.03-0.57)] and it showed a significant correlation with post-operative DeMeester score [r = - 0.28, p = 0.02].

Conclusion: No relationship was found between patient factors such as age, sex, race, and BMI and recurrent reflux following primary fundoplication. However, a Low HPZ post-wrap was a risk factor for recurrent reflux with a risk ratio of 0.15 (0.03-0.57) and a p value of 0.01. Larger studies are needed to evaluate the impact of HPZ on outcomes following fundoplication in order to develop guidelines for clinicians.