Abstract
ABSTRACT
Background
Recurrent symptoms after laparoscopic fundoplication (LF) are not fully understood, with ongoing research focusing on their mechanisms. This study aimed to validate the Padova Classification, a postoperative high‐resolution manometry (HRM) framework to distinguish functioning from defective fundoplications.
Methods
Prospectively collected data from consecutive patients who underwent post‐LF HRM (2010–2025) were analyzed and categorized as functioning and effective LF (FELF), post‐fundoplication outflow obstruction (PFOO), and ineffective neo‐barrier (INB). Primary analysis involved between‐group comparisons. Padova Classification diagnostic accuracy was evaluated against a composite reference standard (clinical, radiological, endoscopic, and pH‐monitoring criteria) by calculating sensitivity, specificity, positive predictive value, and negative predictive value for each diagnostic category. Diagnostic performance of postoperative integrated relaxation pressure (IRP) for identifying PFOO was evaluated using receiver operating characteristic curve analysis.
Key Results
Among 373 patients (42.4% female; median age 54 years, median BMI 25.9 kg/m
2
; 55.2% Nissen, 44.8% Toupet), FELF, INB, and PFOO were observed in 58.7%, 21.4%, and 18.0% of patients, respectively, with PFOO most frequently seen with Nissen fundoplication (
p
= 0.001). The Padova Classification showed sensitivity/specificity 94.7%/97.1% for FELF, 88.8%/96.9% for INB, and 100%/97.4% for PFOO. Postoperative integrated relaxation pressure accurately discriminated PFOO (AUC 0.959–0.984; cutoff 18.1 mmHg; sensitivity 97.7%–98.0%, specificity 93.2%–96.8%), with no difference between ROC curves derived from Padova Classification and reference standard (
p
= 0.12).
Conclusions
This study confirms that the Padova Classification demonstrates strong performance in assessing postoperative LF function.