Gas bloat syndrome significantly worsens outcomes after Nissen fundoplication, revealing critical insights for surgical practice.

• 24.7% of patients experienced gas bloat syndrome one year post-surgery.
• Those with gas bloat reported higher GERD-HRQL scores, lower satisfaction, and increased PPI use (p < 0.01).
• By year five, 46.7% of gas bloat patients had anatomical failures vs. 15.3% without (p < 0.0001), and 28.5% required revisional surgery compared to 8.5% (p < 0.001).

Monitoring gas bloat syndrome is essential for improving long-term surgical outcomes and addressing patient concerns.