Gastroesophageal reflux disease (GERD) is frequently managed surgically with fundoplication in patients with persistent symptoms or abnormal reflux testing. High-resolution manometry (HRM) and pH-impedance monitoring provide objective assessment before and after surgery. This study aimed to evaluate clinical outcomes, symptoms, and physiological parameters in patients undergoing antireflux surgery

We prospectively analyzed 16 patients (37.5% female, mean age 56.4 ± 12.5 years, mean BMI 28.1 ± 3.4) who underwent antireflux surgery (62.5% Nissen, 37.5% Toupet). Preoperative and postoperative assessments included symptoms, GERD-HRQL score, HRM, and pH-impedance monitoring.

Preoperatively, heartburn (81%), regurgitation (63%), and cough (50%) were most common. At follow-up, heartburn (19%) and cough (6%) improved significantly (p=0.006 and p=0.016). Hiatal hernia was identified in 69% on endoscopy (mean size 2.1 cm) and 56% on HRM. Barrett’s esophagus was present in 12.5%. GERD-HRQL score improved from 21.6 ± 11.2 to 3.4 ± 7.6 (p < 0.001). LES pressure and EGJ-CI increased modestly, while distal latency increased (trend, p=0.057). Total AET (acid exposure time) decreased from 6.2% to 3.3% (trend, p=0.088). DeMeester score decreased from 30 (median) to 5.4 (p=0.092), with abnormal values (>14.8) dropping from 62.5% to 31.2%. MNBI improved from 1.95 to 2.40 kΩ, with 43% of abnormal values normalizing. The number of reflux episodes decreased (trend, p=0.055) and bolus clearance improved significantly (p=0.034). MNBI correlated strongly with AET both pre- and post-operatively (r = −0.49 and −0.47). SI and SAP positivity decreased from 7 and 5 patients pre-op to only 2 patients post-op, indicating loss of symptom–reflux association.  Correlation analysis showed that EGJ-CI correlated moderately with reductions in acid exposure, suggesting it may better reflect postoperative reflux control.

Fundoplication resulted in substantial improvement in physiological, anatomical, and symptomatic markers of GERD. These findings support comprehensive pre-operative physiological assessment for optimizing patient selection and predicting outcomes in antireflux surgery.