Five-Year Outcomes of Laparoscopic Hiatal Hernia Repair With Dor Fundoplication Versus Endoscopic Microcurrent Radiofrequency for Gastroesophageal Reflux Disease: A Retrospective Cohort Study

AIM: This study aims to compare the long-term efficacy of laparoscopic hiatal hernia repair with Dor fundoplication (LHRF) and endoscopic microcurrent radiofrequency (EMRF) in the treatment of Gastroesophageal Reflux Disease (GERD). METHODS: This study retrospectively analyzed 340 patients who underwent LHRF and EMRF treatment at our hospital between January 2016 and January 2019. Of these, 160 patients underwent LHRF (surgical group), and 180 patients underwent EMRF (endoscopic group). Baseline information, Gastroesophageal Reflux Disease Health‑Related Quality of Life (GERD‑HRQL) scores, proton pump inhibitor (PPI) use, patient satisfaction, complications, reintervention rates, and other clinical data of both groups were collected and compared. RESULTS: At 6 months after treatment, GERD-HRQL scores were markedly reduced compared with baseline in both groups. Repeated-measures analysis of variance (ANOVA) demonstrated significant effects of group, time, and group × time interaction (all p < 0.001). Over the 5-year follow-up period, GERD-HRQL scores remained consistently lower in the surgical group, whereas scores in the endoscopic group showed a gradual increase from the third postoperative year onward. Regarding PPI use, the discontinuation rate was significantly higher in the surgical group than in the endoscopic group at 6 months (p = 0.028), 1 year (p = 0.027), 3 years (p = 0.021), and 5 years (p = 0.017). Patient satisfaction scores were also significantly higher in the surgical group than in the endoscopic group (p < 0.001). In addition, the surgical group experienced nine complications, predominantly transient dysphagia, while the endoscopic group reported 11 complications, including six cases of transient chest pain and five cases of nausea. The difference in overall postoperative complication rates between the two groups was not statistically significant (χ2 = 0.238, p = 0.626). Regarding reintervention, three patients in the surgical group (4.76%) required further treatment, mainly due to wrap disruption. In the endoscopic group, five patients underwent reintervention: two cases of EMRF failures required LHRF, and three required repeat EMRF. The difference in reintervention rates between the two groups was not statistically significant (χ2 = 0.133, p = 0.715). CONCLUSIONS: LHRF demonstrates clear clinical benefits and long-term efficacy in the treatment of GERD, providing evidence to inform the selection of surgical approaches and overall clinical treatment strategies.