Abstract

Laparoscopic Nissen fundoplication is a widely used surgical technique for the treatment of hiatal hernia. However, variability in clinical outcomes suggests a potential influence of anatomical and functional characteristics of the disease. To evaluate the clinical outcomes of laparoscopic Nissen fundoplication in patients with hiatal hernia and to analyze their relationship with morphofunctional features. A retrospective–prospective observational study included 63 patients who underwent laparoscopic hiatal hernia repair with posterior cruroplasty and Nissen fundoplication. Patients were stratified according to anatomical type of hernia. Clinical, endoscopic, and imaging data were analyzed. Outcomes were assessed at 10, 30 days, and at 3 and 12 months after surgery. Axial hernias were associated with a predominance of reflux symptoms, while paraesophageal and mixed forms more frequently presented with dysphagia and retrosternal pain. At 10 days after surgery, good outcomes were observed in 50.0% of patients with axial hernias compared with 11.1% in mixed forms, while unsatisfactory outcomes reached 55.6% in mixed hernias. At 12 months, good outcomes were maintained in 75.0% of axial hernias and 62.5% of paraesophageal hernias, whereas unsatisfactory outcomes persisted in 22.2% of patients with mixed hernias. Anatomical complexity was consistently associated with less favorable outcomes (p<0.05). Laparoscopic Nissen fundoplication provides stable clinical results in patients with less complex anatomical forms of hiatal hernia. Variability of outcomes is associated with morphofunctional characteristics of the disease and should be considered in clinical evaluation.