Laparoscopic Toupet Fundoplication for Lung Transplant Recipients: Outcomes and Effects on Symptoms

Abstract

INTRODUCTION: Lung transplant (LTx) recipients often experience GERD, which predisposes them to bronchiolitis obliterans syndrome and obstructive chronic lung allograft dysfunction, ultimately resulting in early rejection and death. Laparoscopic Nissen fundoplication (LNF) has historically been the procedure of choice for LTx-related GERD. However, LNF is associated with high rate of postoperative dysphagia and bloating in the general population. Hence, we evaluate laparoscopic Toupet fundoplication (LTF) as an option for antireflux surgery in LTx recipients, investigating the effects of LTF on DeMeester score, gastric emptying, esophageal manometry, and patient symptoms. METHODS: A retrospective review of LTx patients who underwent LTF at a single center by 1 surgeon (n = 59) between September 2018 and November 2020 was performed, excluding a patient who had a revision of their fundoplication. Preoperative and postoperative esophageal manometry, gastric emptying studies, and patient-reported GERD symptoms were collected. Statistical analyses were performed using Prism 9 Version 9.3.1 for macOS, GraphPad Software. RESULTS: After LTF, DeMeester score and relative risk of abnormal esophageal function and gastroparesis were significantly decreased, with most patients having lower gastroparesis severity score. Reports of heartburn, regurgitation, and bloating were also reduced. However, the rates of dysphagia were similar. There was no decline in pulmonary function. CONCLUSION: LTF, in addition to providing antireflux control in LTx recipients, has low rate of complication and trends with overall improvement of gastrointestinal issues. LTF ultimately has the potential to be the antireflux operation of choice in LTx recipients, protecting against early rejection and death.