• Christopher J Zimmermann, Kristine Kuchta, Julia R Amundson, Vanessa N VanDruff, Stephanie Joseph, Simon Che, H Mason Hedberg, and Michael B Ujiki.
• Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
• J. Am. Coll. Surg. 2024 Apr 26.

BackgroundAnti-reflux procedures (ARPs) are effective treatments for gastroesophageal reflux disease (GERD). However, variation in objective and patient reported outcomes persists. Limited evidence and anecdotal experience suggest that patient sex may play a role. The objective of this study was to compare outcomes after ARPs between male and female patients.Study DesignWe performed a retrospective review of a prospectively maintained database at a single institution. All patients who underwent an ARP for GERD were included. Demographic, clinical, and patient reported outcomes data (GERD-Health Related Quality of Life, Reflux Symptom Index), as well as radiographic hernia recurrence were collected and stratified by sex. Uni- and multivariable logistic and mixed effects linear regression were used to control for confounding effects.ResultsBetween 2009 and 2022, 934 patients (291 males, 643 females) underwent an ARP. Reflux Symptom Index, GERD-HRQL, and gas/bloat scores improved uniformly for both sexes, though female patients were more likely to have higher gas/bloat scores one year post-procedure (mean ± SD 1.7 ± 1.4 vs 1.4 ± 1.3, p=0.03) and higher GERD-HRQL scores two years post-procedure (6.3 ± 8.1 vs 4.7 ± 6.8, p=0.04). Higher gas/bloat scores in females persisted on regression controlling for confounders. Hernia recurrence rates were low (85 patients, 9%) and were similar for both sexes. A final intraprocedural DI ≥3mm 2/mmHg was significantly associated with a 7 times higher rate of recurrence (95% CI 1.62-31.22, p=0.01).ConclusionsWhile patients of either sex experience symptom improvement and low rates of recurrence after ARPs, females are more likely to endorse gas/bloat compared to males. Final distensibility ≥3mm 2/mmHg carries a high risk of recurrence. These results may augment how physicians prognosticate during consultations and tailor their treatments in patients with GERD.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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