Postoperative Outcomes of Anti-Reflux Surgery in Lung Transplant Recipients

Jacob Parker; William N Doyle; Pavani Peddi; Monica Stevens; Michael Rogers; Rahul Mhaskar; Kapilkumar Patel; Christopher DuCoin

doi:10.1016/j.gassur.2025.102126

Postoperative Outcomes of Anti-Reflux Surgery in Lung Transplant Recipients

J Gastrointest Surg. 2025 Jun 19:102126. doi: 10.1016/j.gassur.2025.102126. Online ahead of print.

Authors

Jacob Parker¹, William N Doyle¹, Pavani Peddi², Monica Stevens³, Michael Rogers⁴, Rahul Mhaskar⁵, Kapilkumar Patel⁶, Christopher DuCoin⁷

Affiliations

¹ University of South Florida Morsani College of Medicine, Tampa, FL.
² Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, Tampa, FL.
³ MaineHealth - Maine Medical Center, Portland. ME.
⁴ Department of Cardiothoracic Surgery, New York Presbyterian-Weill Cornell Medical Center, New York, NY.
⁵ Medical Student Research, University of South Florida Morsani College of Medicine, Tampa, FL.
⁶ Tampa General Hospital Advanced Lung Disease & Transplant Center, University of South Florida Morsani College of Medicine.
⁷ Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine.

PMID: 40543600
DOI: 10.1016/j.gassur.2025.102126

Abstract

Background: Gastroesophageal reflux disease (GERD) is a risk factor for aspiration and lung allograft rejection. Anti-reflux surgery (ARS) can be utilized for these patients to improve GERD and abate the decline of lung function. Accordingly, this study seeks to compare the efficacy of different accepted ARS techniques in lung transplant populations.

Methods: A single-center retrospective cohort study of lung transplant recipients who underwent ARS between 2011 - 2023 was performed. GERD symptoms were based on proton-pump inhibitor (PPI) usage postoperatively. Pulmonary function testing, postoperative complications, dysphagia complaints, and endoscopic or surgical revisions were also evaluated and compared using Chi-square and Wilcoxon rank-sum tests. P≤0.05 denoted significance.

Results: Ninety-six patients underwent Nissen (49.0%), Toupet (46.9%), or Dor (1.0%) fundoplication, or magnetic sphincter augmentation (MSA, 3.1%). Nissen fundoplication patients had increased rates of PPI usage at 3- (93% vs 54.8%, p<0.001) and 6-months (90.7% vs 40.5%, p<0.001) postoperatively with no significant differences at most recent follow up when compared with Toupet patients. Between Nissen and Toupet fundoplication patients, differences in rates of post-operative dysphagia (45.7% vs 42.2%, p=0.678), endoscopic dilation (17.4% vs 22.2%, p=0.219), and revisional surgery (8.7% vs 2.2%, p=0.140) were statistically insignificant. No significant differences in FEV1 (1.98L vs. 2.04L, p=0.470) or in median FEV1 percent change (1.96% vs. 0.98% respectively, p=0.524) pre- to post-ARS were identified when comparing Nissen vs. Toupet.

Conclusion: Considering lower PPI usage at 3- and 6- months post-ARS, Toupet fundoplication is superior to Nissen in decreasing PPI use in lung transplant recipients. Postoperative dysphagia, reintervention, and pulmonary function outcomes are similar between Toupet and Nissen patients.

Keywords: Bronchiolitis Obliterans; Fundoplication; Gastroesophageal Reflux; Lung Transplantation.