Inverse Probability of Treatment Weighting Analysis of Long-term Recurrence and Redo Rates After Laparoscopic Versus Open Toupet Fundoplication in Children.

BACKGROUND: Laparoscopic Toupet fundoplication (LTF) and open Toupet fundoplication (OTF) are accepted treatments for pediatric patients with gastroesophageal reflux disease (GERD). However, comparative studies that adjust for baseline patient differences between the two approaches remain limited. This study aimed to evaluate the long-term outcomes of LTF compared with OTF using inverse probability of treatment weighting (IPTW) analysis. METHODS: We retrospectively reviewed pediatric patients (aged <18 years) who underwent LTF or OTF for GERD between 2010 and 2025 at our tertiary center. Propensity scores incorporated body weight, congenital heart anomalies, history of abdominal surgery, gastrostomy tube placement, esophageal atresia, and neurological impairment. A stabilized IPTW method generated a weighted cohort. Long-term GERD recurrence and redo fundoplication rates were compared using weighted Kaplan-Meier curves and IPTW-adjusted Cox proportional hazards models. RESULTS: A total of 163 patients (119 LTF, 44 OTF; median follow-up, 4.8 years) were included. Total GERD recurrence and redo rates were 4.9% and 4.3%, respectively. After IPTW adjustment, covariate balance improved substantially (standardized mean differences <0.15). IPTW-adjusted analysis revealed no significant differences between the LTF and OTF groups regarding GERD recurrence (Hazard Ratio [HR], 0.23; 95% Confidence Interval [CI], 0.04-1.30; p=0.10) or redo fundoplication rates (HR, 0.79; 95% CI, 0.14-4.37; p=0.78). CONCLUSION: Following rigorous adjustment for baseline characteristics, LTF demonstrated long-term GERD recurrence and redo fundoplication rates comparable to OTF. LTF is a safe and effective long-term surgical option for pediatric GERD, providing outcomes equivalent to the open approach. LEVEL OF EVIDENCE: Level III.