202 Beware of Functional Disorders Before Undertaking Revisional Fundoplication – the Role of the Specialist Benign Oesophagogastric MDT

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Abstract Aim Symptomatic failure of anti-reflux surgery may reflect functional gastrointestinal (GI) disorders rather than surgical failure. A regional specialist benign Oesophago-Gastric (OG) multidisciplinary team (MDT) provides expert evaluation of benign OG disorders. This study aimed to assess the MDT’s role in identifying functional diagnoses and guiding appropriate management in patients with ongoing symptoms after anti-reflux surgery. Method A retrospective review was undertaken of all cases discussed in the regional specialist benign OG MDT at a UK tertiary referral centre between January 2023 and May 2025. Patients with ongoing or recurrent symptoms following fundoplication were identified for inclusion. All patients underwent gastroscopy, oesophageal physiology testing and barium swallow prior to discussion. The primary outcome was the proportion of patients diagnosed with a functional GI disorder. Results Of 105 total cases discussed, 16 patients (15%) presented with ongoing or recurrent symptoms following fundoplication, most commonly laparoscopic Nissen fundoplication (90%). The cohort was 90% female, with a median age of 54 years (range 25–77). Median time to MDT discussion was 19 months post-operatively. Specialist review identified supra-gastric belching in one patient who was referred for cognitive behavioural therapy. Three patients were diagnosed with reflux hypersensitivity and started on selective serotonin reuptake inhibitors. Conclusions One in four patients being considered for revisional surgery had a functional GI disorder. Specialist MDT review facilitated diagnosis and appropriate non-surgical management. The specialist benign OG MDT identified a significant proportion of patients in whom revisional surgery would have been contraindicated. An MDT approach to complex anti-reflux surgery should be nationally mandated.