Hiatal Hernia Research Articles

Sleeve Migration Following Sleeve Gastrectomy: A Systematic Review of Current Literature.

Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. The incidence and consequences of sleeve migration (SM) are not clearly understood. There is no clear consensus on appropriate measures to reduce the risk of SM. This study systematically reviewed the literature and identified 405 cases of SM from 21 studies. Age ranged from 18 to 68 years. Thirty-two percent and 11% of patients were females and males respectively, while sex was not reported in 57%. Time to diagnosis ranged from 1 day to 5 years postoperatively. A total of 9.6% and 58.8% of patients had or had no previous hiatal hernia respectively. SM incidence, risk factors, proposed mechanisms, clinical presentation, diagnosis, management, and potential preventive strategies are described in this review.

Functional results after hiatal repair and gastropexy without fundoplication in patients with paraoesophageal hernia

PurposeParaoesophageal hernias (PEH) are associated with a high complication rate and often occur in elderly and fragile patients. Surgical gastropexy without fundoplication is an accepted alternative procedure; however, outcomes and functional results are rarely described. Our study aims to evaluate short-term outcomes and the long-term quality of life after gastropexy as treatment for PEH.MethodsSingle center cohort analysis of all consecutive patients who underwent gastropexy for PEH without fundoplication. Postoperative outcomes and functional results were retrospectively collected. Reflux symptoms developed postoperatively were reported using the validated quality of life questionnaire: GERD-Health Related Quality of Life Qestionnaire (GERD-HRQL).ResultsThirty patients (median age: 72 years (65–80)) were included, 40% classified as ASA III. Main PEH symptoms were reflux (63%), abdominal/thoracic pain (47%), pyrosis (33%), anorexia (30%), and food blockage (26%). Twenty-six laparoscopies were performed (86%). Major complications (III-IVb) occurred in 9 patients (30%). Seven patients (23%) had PEH recurrence, all re-operated, performing a new gastropexy. Median follow-up was 38 (17–50) months. Twenty-two patients (75%) reported symptoms resolution with median GERD-HRQL scale of 4 (1–6). 72% (n = 21) reported operation satisfaction. GERD-HRQL was comparable between patients who were re-operated for recurrence and others: 5 (2–19) versus 3 (0–6), p = 0.100.ConclusionGastropexy without fundoplication was performed by laparoscopy in most cases with acceptable complications rates. Two-thirds of patients reported symptoms resolution, and long-term quality-of-live associated to reflux symptoms is good. Although the rate of PEH recurrence requiring a new re-intervention remained increased (23%), it does not seem to affect long-term functional results.

Surgical Management of Persistent or New Symptoms After Hiatal Hernia Repair.

Following a hiatal hernia repair, patients can present with recurrent or new symptoms. Symptoms can occur anywhere from weeks to years after surgery. These may include recurrent reflux, dysphagia, regurgitation, weight loss, or deteriorating quality of life. While nonoperative management can be pursued in some patients, reoperation may be the only option in select patients. A thorough preoperative workup, including a repeat esophagram, upper endoscopy, +/- chest computed tomography (CT) scan, manometry, pH probe, and/or gastric emptying study, is warranted to better understand the pathophysiology of the presenting symptoms. If a recurrent hernia, slipped, or migrated wrap is identified, surgery is considered. Pseudoachalasia must also be ruled out if obstructive symptoms are observed at the hiatus. Such an exhaustive workup is indeed necessary to ensure accurate diagnosis and optimal outcome. In addition, an understanding of the factors that may have led to the recurrence will increase the chances of a successful reoperation. Although a technically demanding procedure, redo hiatal hernia repair utilizing a minimally invasive approach is increasingly being employed with promising outcomes. Herein, the steps of a redo hiatal hernia repair via a minimally invasive approach will be outlined and detailed.

Previously unrecognized Morgagni’s hernia presenting with bowel obstruction: a rare case report

Introduction and importance: Morgagni’s hernia (MH) is a rare entity, it is defined by the protrusion of abdominal viscera through an anterior retrosternal diaphragmatic defect. It is mainly diagnosed during the perinatal and neonatal periods. A few cases have been reported in adults. The objective of this study was to report the case of a patient with an unrecognized MH, review the current literature on Morgani hernias in the adult population, and assess their clinical characteristics and therapeutic approach reported in adults. We here describe a rare case of a MH presenting with bowel obstruction as the primary symptom in adult life. Case presentation: A 52-year-old man presented to the emergency department with a bowel obstruction. The abdominal CT tomography showed an intestinal bowel obstruction above the hiatal hernia with an intrathoracic ascending colon. Exploratory laparotomy revealed a bilateral strangulated diaphragmatic hernia of Morgagni. The patient underwent closure of the diaphragmatic defect under tension by X-stitch. The recovery was uneventful, and the patient is in good health after 12 months of follow-up. Clinical discussion: The Morgagni hernias are usually asymptomatic; complications such as strangulation of the herniated colon or herniated stomach by stricture are exceptional. Surgical treatment is always recommended for MH. Postoperative complications are rare in simple diaphragmatic hernias, and the course is generally favorable. Conclusion: MH is the rarest form of congenital diaphragmatic hernia, with nonspecific symptomatology contributing to the delay in diagnosis. The cure is surgical, and the open surgical approach is preferable in emergency cases, while laparoscopic surgery is favored in elective settings and is associated with shorter hospitalization. Further studies are crucial in order to elucidate etiology and optimal therapeutic approach.

Etiological and clinical profiles of patients with dysphagia: A teaching institution experience.

Dysphagia can involve any structure from the mouth to the lower esophageal sphincter. The etiologies vary from benign causes to malignant lesions. There is dearth of data regarding dysphagia in our population. A total of 208 patients with complaints of dysphagia were screened for the study. After ruling out neurological/local oropharyngeal causes of dysphagia, 200 patients with suspected esophageal dysphagia (ED) were recruited in the study. Dysphagia was graded as per the dysphagia scoring system. All patients underwent upper gastro-intestinal endoscopy and were evaluated for the presence of mechanical and non-mechanical causes of ED. The mean age of patients with dysphagia was 53.8 ± 15.4 years. with males and females being 82 and 118, respectively. The mean duration of the symptom was 7.2 ± 10.6 months (median 3 months). Ninety-eight patients (49%) having dysphagia were in the age group of 56-65 years. The dysphagia score was 0 among 58, and 4 among 26 subjects. Foreign body sensation was the most frequent chief complaint in 90 (45%) patients. Ninety-six (48%) and 104 (52%) patients had mechanical and non-mechanical causes of dysphagia, respectively. Among mechanical causes of dysphagia, 68 patients (70.8%) had esophageal growth and 28 (29.2%) had esophageal stricture. Sixty-seven patients had squamous cell carcinoma. Among non-mechanical causes, 50 (48.1%) had globus sensation, 24 (23.1%) had hiatus hernia, and 16 (15.4%) functional dysphagia. Dysphagia is a common problem with varied etiologies. The esophageal growth and globus sensation are among the predominant causes of ED. We stress that all patients of dysphagia must be meticulously investigated.

Innovative esophageal lengthening surgical technique in giant hiatal hernia repair

Innovative esophageal lengthening surgical technique in giant hiatal hernia repair

AB104. SOH24AB_054. Reducing recurrence rates in hiatal hernia repair: results of a quality improvement study

AB104. SOH24AB_054. Reducing recurrence rates in hiatal hernia repair: results of a quality improvement study

Antireflux surgery in patients with gastroesophageal reflux but a negative 24-hour pH study: late outcomes

PurposePatients with gastroesophageal reflux disease often undergo a 24-hour pH test to confirm pathologic reflux before surgery. However, a negative pH test can occur in some individuals with reflux, and a case might still be made for antireflux surgery based on symptoms of reflux even in the absence of endoscopic esophagitis. The long-term outcomes in patients who underwent antireflux surgery despite negative preoperative test results were determined. MethodsPatients were selected from a prospective database. A total of 745 patients met the inclusion criteria, which included typical esophageal reflux symptoms, absence of a large hiatus hernia, preoperative 24-hour pH study performed, endoscopy, and postoperative symptom and satisfaction follow-up available at 5 years. Patients were divided into 3 groups based on 24-hour pH study and endoscopy results: negative pH and negative endoscopy (n = 65), negative pH and positive endoscopy (n = 72), and positive pH (n = 608). The negative pH and negative endoscopy group underwent surgery based on clinical assessment and typical esophageal reflux symptoms. Baseline and follow-up outcomes at 5 years were evaluated using 0 to 10 analog scores, which assessed heartburn, dysphagia, and satisfaction with the overall outcome. Data were analyzed to compare the groups. ResultsThe groups were well matched for demographics and preoperative symptom scores. At the median 5-year follow-up, clinical outcome scores were similar among the groups for heartburn, dysphagia, and overall satisfaction. The mean heartburn scores were 1.80 in the negative pH and negative endoscopy group, 1.88 in the negative pH and positive endoscopy group, and 1.91 in the positive pH group (P = .663). The mean satisfaction scores were high in all groups: 8.13, 7.31, and 7.72, respectively (P = .293). ConclusionNo difference in clinical outcome scores was observed. The negative pH and negative endoscopy group had high satisfaction scores and low heartburn and dysphagia scores. Our findings support antireflux surgery in well-selected symptomatic patients with a negative preoperative pH test.

BIOCHEMICAL INDICATORS OF GASTRIC JUICE IN INCOMPETENCE OF THE PHYSIOLOGICAL GASTRIC CARDIA

Aim. This study aimed to evaluate the biochemical characteristics of gastric juice in cases incompetence of the physiological cardia (IPC) at the gastroesophageal junction. Methods. Gastric juice samples were collected from 42 patients diagnosed with hiatal hernia (HH) at the State Institution "Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine". Patients were classified into type I (sliding) HH (n=26) and type II (paraesophageal) HH (n=16), with a control group of healthy volunteers (n=9). Results. Analysis included pH, pepsin concentration, bile acids, total calcium and stable metabolites of nitric oxide (NOx). In type I HH, gastric juice showed increased pH (3.73±0.49) and elevated pepsin concentration (1.33±0.22 mg/ml) compared to controls (p<0.01 and P<0.05 respectively), indicating hypoacidity and hyperfunction of chief cells. Type II HH exhibited pH levels (2.34±0.72) similar to controls and no significant difference in pepsin concentration. NOx levels in type I HH were lower (P<0.05) compared to controls, suggesting reduced NOergic system activity. Calcium concentration in gastric juice did not significantly differ between groups. Conclusions. These findings suggest that type I HH is associated with disturbances in gastric secretion regulation, possibly unrelated to duodenogastric reflux. Further investigation is warranted to elucidate the underlying pathophysiological mechanisms.

A Retrospective Analysis of Cases Evaluated by Endoscopy in a Newly-Established Endoscopy Unit at A Second-Level Hospital

The aim of this study is to retrospectively analyze the cases who underwent upper and lower gastrointestinal system endoscopic evaluation between 2021-2022 in the endoscopy unit, which was established for the first time in a second level hospital, and to emphasize the importance of endoscopy units in district hospitals located far from central hospitals. The study comes to the fore in terms of dealing with the data of a district hospital where an endoscopy unit was established for the first time. The data of 440 patients who underwent endoscopic evaluation were analyzed. The study included 320 patients who underwent upper gastrointestinal tract and 120 who underwent lower gastrointestinal tract endoscopic examination. The endoscopic and pathological diagnoses given to patients were examined based on the data obtained, and descriptive statistics were performed. The cases undergoing upper gastrointestinal endoscopic examination had a mean age of 53.93±16.14 years, and those undergoing lower gastrointestinal tract endoscopic examination had a mean age of 53.71±15.86. Of cases undergoing upper gastrointestinal tract endoscopic examination, 70.3% had antral gastritis (n=225), 34.8% had ulcers (n=111), 10.3% had hiatus hernia (n=28), 9.1% had esophagitis (n=29), and 9.1% had duodenitis (n=29). Among the cases endoscopically diagnosed with cancer, 0.9% were localized in the distal esophagus (n=3) and 0.6% in the antrum (n=3). Of cases undergoing lower gastrointestinal tract endoscopic examination, 20% were diagnosed with polyp (n=24), 10% with diverticulum (n=12), 3.3% with hemorrhoidal disease (n=4), and 5% with cancer (n=6). As a result, the data obtained from the study emphasize the importance of endoscopy units in district hospitals located far from central hospitals.

Large intrathoracic collection secondary to acute chronic pancreatitis displacing large hiatal hernia, an uncommon presentation.

Abstract The case of a 60-year-old woman with a history of chronic alcoholism and chronic liver disease is presented as a clinical case. During a hospitalization, a diagnostic imaging test reveals a possible complicated chronic pancreatitis with multiple abdominal collections. Of note is the displacement of one of the collections at the thoracic level along with a pre-existing large hiatal hernia, which, in turn, is compressed and laterally displaced by the collection, causing abdominal pain and dyspnea in the patient. Literature on intrathoracic collections secondary to complicated chronic pancreatitis is scarce. Therefore, in a patient presenting with typical abdominal pain of pancreatitis and dyspnea, it is mandatory to consider this condition in the broad differential diagnosis that needs to be established.

Invited Commentary: Can More Liberal Use of Collis Gastroplasty in Laparoscopic Paraesophageal Hernia Repair Reduce Recurrence?

Invited Commentary: Can More Liberal Use of Collis Gastroplasty in Laparoscopic Paraesophageal Hernia Repair Reduce Recurrence?

Guidelines in Practice: A Safe Environment of Care.

Creating a safe environment for performing surgical procedures is essential to achieve successful patient outcomes and protect the perioperative personnel who are providing care. Numerous factors challenge the provision of a safe environment of care and create a complex setting for perioperative nurses to manage. The updated AORN "Guideline for a safe environment of care" provides perioperative nurses with recommendations for establishing a safe environment for both patients and personnel. This article provides an overview of the guideline and discusses recommendations for implementing fire safety protocols, using warming cabinets, and creating a latex-safe environment. It also includes a scenario describing the care of a patient with an unidentified latex allergy who is undergoing a laparoscopic sleeve gastrectomy and hiatal hernia repair. Perioperative nurses should review the guideline in its entirety and implement recommendations as applicable in operative and other procedural settings.

Personalized anti-reflux surgery: connecting GERD phenotypes in 690 patients to outcomes.

Anti-reflux operations are effective treatments for GERD. Despite standardized surgical techniques, variability in post-operative outcomes persists. Most patients with GERD possess one or more characteristics that augment their disease and may affect post-operative outcomes-a GERD "phenotype". We sought to define these phenotypes and to compare their post-operative outcomes. We performed a retrospective review of a prospective gastroesophageal database at our institution, selecting all patients who underwent an anti-reflux procedure for GERD. Patients were grouped into different phenotypes based on the presence of four characteristics known to play a role in GERD: hiatal or paraesophageal hernia (PEH), hypotensive LES, esophageal dysmotility, delayed gastric emptying (DGE), and obesity. Patient-reported outcomes (GERD-HRQL, dysphagia, and reflux symptom index (RSI) scores) were compared across phenotypes using the Wilcoxon rank-sum test. 690 patients underwent an anti-reflux procedure between 2008 and 2022. Most patients underwent a Nissen fundoplication (302, 54%), followed by a Toupet or Dor fundoplication (205, 37%). Twelve distinct phenotypes emerged. Non-obese patients with normal esophageal motility, normotensive LES, no DGE, with a PEH represented the most common phenotype (134, 24%). The phenotype with the best post-operative GERD-HRQL scores at one year was defined by obesity, hypotensive LES, and PEH, while the phenotype with the worst scores was defined by obesity, ineffective motility, and PEH (1.5 ± 2.4 vs 9.8 ± 11.4, p = 0.010). There was no statistically significant difference in GERD-HRQL, dysphagia, or RSI scores between phenotypes after five years. We have identified distinct phenotypes based on common GERD-associated patient characteristics. With further study these phenotypes may aid surgeons in prognosticating outcomes to individual patients considering an anti-reflux procedure.

Paraesophageal hernia mimicking pneumatocele in an infant: A diagnostic dilemma

A defect in the oesophageal hiatus can result in the herniation of the stomach or other abdominal organs into the thoracic cavity, known as a hiatal hernia. These hernias are uncommon in infants and children, and their symptoms can be vague and non-specific, posing challenges for even experienced clinicians to make a diagnosis. Regardless of the case, surgical intervention is necessary due to the potentially life-threatening complications associated with this condition. We present a rare case of a 2-month-old infant with congenital paraesophageal hernia (PEH) who initially came to our hospital with a diagnosis of pneumonia with pneumatocele. Based on clinical presentation and radiological examinations, the infant was correctly diagnosed with PEH and gastric volvulus. The patient underwent emergency surgical correction and was discharged in a stable condition. It is crucial to have a thorough understanding of the clinical presentation and maintain a high level of suspicion to ensure timely diagnosis and appropriate management in these cases.

Barrett’s Esophagus Risk Factors in Patients Without Gastroesophageal Reflux: A Large Population-Based Study

Esophageal adenocarcinoma (EAC) is a lethal malignancy with an abysmal 5-year survival rate of <20%.1 Barrett's esophagus (BE) is the only known precursor to EAC.1,2 BE is characterized by intestinal metaplasia of the distal esophagus, typically arising in the setting of gastroesophageal reflux disease (GERD).1 Hence, chronic GERD symptoms are an essential criterion for BE screening in most gastroenterology guidelines, alongside other BE risk factors including age >50 years, male sex, White race, history of tobacco smoking, hiatal hernia (HH) diagnosis, obesity, and family history of BE/EAC in first-degree relatives.1,3 Dysplastic BE and early stage EAC are amenable to endoscopic eradication therapy, highlighting the importance of BE/EAC screening and surveillance.4.

P029 Successful treatment of Rapidly progressive MDA-5 with dual combination therapy as a bridge to lung transplantation

Abstract Background/Aims Anti-melanoma differentiation-associated gene 5 (MDA5) is known to be associated with rapidly progressive interstitial lung disease (RP-ILD) and is fatal in most cases. The aim of this case report is to highlight the importance of early detection and aggressive treatment in improving the survival of these patients. Methods A 48-year-old Caucasian man, ex-smoker with 20 pack year history with well-controlled asthma, GORD, hiatus hernia and chondrocalcinosis in right knee on hydroxychloroquine was noted to have finger clubbing and decreased air entry at the right lung base on routine follow up. He worked in print finishing for 18 years. Results Investigations: CXR-increased interstitial shadowing. CT chest-extensive fibrosis NSIP pattern with honey combing, traction bronchiectasis throughout both lung fields and ground glass changes at the lower lobes. FVC 2.99 (63% predicted), FEV1 2.82 (73% predicted), FEV1/FVC ratio 0.95%, TLCO 2.75 (25% predicted), KCO 0.70 (46% predicted). CK- 76, Myositis blot- MDA 5 +ve, c ANCA +ve, PR3&amp;MPO -ve and ANA -ve. CRP 70. Bronchoscopy-normal. He received IV methyl prednisolone 1 gm x 3 followed by prednisolone 60 mg daily and tapering dose along with Cyclophosphamide IVI 1 gm x 6 cycles. Long term home oxygen was prescribed. As he did not improve on initial immunosuppressive treatment, Rituximab IVI 1 gm x 2 was administered within two months of initial therapy. He was referred for lung transplant. As maintenance, he was on mycophenolate 1.5 gm BD, prednisolone 10 mg OD, Co-trimoxazole 960 mg x 3 days per week and rituximab 1 gm at six months and 12 months. He had bilateral lung transplant in Cambridge after two years from the diagnosis. Unfortunately, he developed organizing pneumonia, primary graft dysfunction requiring a brief ITU admission and tracheostomy soon after the transplant. His current medications include Prednisolone 5mg, Mycophenolate 2g Tacrolimus 3mg mane, 2mg nocte, Azithromycin 250mg three times weekly and Septrin 480mg od. He is now managing well, cycling 10-15 miles daily. He no longer requires ambulatory oxygen. His most recent FEV1 4.1L, FVC4.9L and resting saturation 97%. Dual combination aggressive immunosuppressive therapy led to significant disease control in this patient, enabling him to be enlisted for and finally to receive a double lung transplant within a reasonable time limit. It has been reported that patients with MDA 5 ILD have a 1-year survival of 67.5% and a 3-year survival of 46.7%. Conclusion Key Learning Points: Patients with MDA5-ILD have significantly high mortality rate but early diagnosis and optimal treatment combination can lead to favourable outcomes. These patients should be monitored for opportunistic infections. Patient commitment is important. Our patient stopped smoking, reduced weight to improve fitness to optimise the transplant success. Disclosure K. Yein: None. S. Sadiq: None. S. Zeb: None. A. Ahmed: None. E. Price: None.

The index of failure of the antireflux function of the cardia (IFAFC), as a criterion for the effectiveness of its videolaparoscopic correction for gastroesophageal reflux disease (gerd) in pthe index of failure of the antireflux function of the cardia after video-laparoscopic correction in gerd patients with hiatal hernia

The purpose of the study was to create an index based on the total results of special research methods that characterizes the antireflux function of the cardia in the long term after its video-laparoscopic correction in GERD patients with hiatal hernia (HH). Long-term results of video-laparoscopic antireflux intervention in 213 patients with GERD and HH were analyzed. Based on the results of a remote survey and instrumental examination, the patients were divided into three groups. The first group consisted of the patients who had symptoms of GERD, but the presence of pathological gastroesophageal reflux was not confirmed by instrumental methods (122 patients, 57.3 %); the second group included the patients with recurrent GERD (19 patients, 8.9 %); the third group (72 patients, 33.8 %) consisted of the patients without GERD symptoms or its recurrence. To assess the antireflux function of the cardia in the long term after its video-laparoscopic correction, the index of failure of the antireflux function of the cardia (IFAFC) was developed based on the generalized results of instrumental research methods. Before surgery in all groups of the patients, the IFAFC did not have a statistically significant difference and indicated a very significant severity of signs of failure of the antireflux function of the cardia (0.70±0.06, 0.74±0.05, and 0.70±0.06, respectively; р&gt;0.05). In the long term after surgery, the patients with false-positive GERD symptoms showed an improvement in the IFAFC by 87.14 % (p&lt;0.001), the patients without symptoms of GERD and its recurrence — by 92.86 % (p&lt;0.001), and the patients with recurrent GERD — by 16.22 % (p&lt;0.05). The IFAFC allows assessing the results of the antireflux surgery. In the absence of recurrent GERD, the IFAFC is 0.05±0.01; in patients with recurrent GERD, it is 0.62±0.07. The IFAFC equal to 0.09±0.07 is typical for patients at risk with false-positive symptoms of GERD without confirmation of its relapse by special studies. These patients require follow-up.

True parahiatal hernia: a case of laparoscopic management for a rare type of diaphragmatic hernia

Parahiatal hernias are the rare variant of a diaphragmatic hernias. They are characterized by the formation of the neck of the hernia sac laterally to the diaphragm crura (usually the left), which distinguishes them from hiatal hernias. Hernia usually affects the fundus and body of the stomach, the esophagogastric junction remains below the level of the diaphragm, and clinical manifestations are associated with episodes of strangulation or axial volvulus. The article describes a case of parahiatal hernia complicated by chronic gastric volvulus with subsequent development of acute axial volvulus, which required urgent laparoscopic management.

Toupet fundoplication to prevent progression of scleroderma-associated interstitial lung damage: a study protocol

Summary Background Systemic sclerosis (SSc) is a rare autoimmune and multiorgan disorder. Hallmarks of the disease include inflammation, endothelial dysfunction, and dysregulation of fibroblasts leading to fibrosis of the skin and internal organs. The esophagus is often involved, with up to 80% of patients developing gastroesophageal reflux disease (GERD). Reflux can be associated with hiatal hernia and several complications such as erosive esophagitis, peptic stricture, Barrett’s esophagus, aspiration pneumonia, and chronic microaspiration. Silent aspiration can lead to interstitial lung disease (ILD) in up to 50% of patients with scleroderma and accounts for up to 40% of mortality. Treatment of GERD in patients with SSc is challenging. Proton pump inhibitors (PPI) have been shown effective in relieving typical GERD symptoms, but up to 40% of patients are non-responders. Various antireflux surgical procedures have been proposed to treat GERD and to modify the natural course of the disease by preventing lung damage in these patients. However, current algorithms consider only the degree of esophageal dilation as a marker of disease severity/progression, and results of antireflux surgery remain controversial. Methods We propose a feasibility, observational, multicenter, single-arm trial including adult patients diagnosed with SSc. Criteria for inclusion are individuals with GERD symptoms refractory to PPI, absence of peptic stricture at baseline endoscopy, high-resolution computed tomography (HRCT) scan showing no or less than 10% lung fibrosis, forced vital capacity at least 40% of the predicted value, and diffusing capacity of lung for carbon monoxide 30–89% of the predicted value. A laparoscopic partial posterior fundoplication according to the Toupet technique will be performed. Primary study outcome is the efficacy of fundoplication to reduce reflux exposure measured with a pH-impedance study or 4‑day wireless pH recording. Secondary outcomes include endoscopic, HRCT, and respiratory function tests findings as well as quality of life at 12-month follow-up. Conclusions The expected reduction of reflux burden in SSc patients selected for Toupet fundoplication may improve GERD symptoms/complications, pulmonary function, and quality of life, and may be associated with a reduced risk for lung transplant.