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USING IMPEDANCE PLANIMETRY (ENDOFLIP®) IN THE OPERATING ROOM TO ASSESS THE GASTROESOPHAGEAL JUNCTION AND PREDICT PATIENT OUTCOMES FOLLOWING FUNDOPLICATION

Bailey Su, MD, Stephanie Novak, MS, Zachary Callahan, MD, Kristine Kuchta, MS, Joann Carbray, BS, Michael Ujiki, MD. NorthShore University Health System

Introduction: Our purpose is to evaluate the utility of using a functional luminal imaging probe (EndoFLIP®) intra-operatively to assess adequacy of hiatal hernia repair and fundoplication.  Additionally, we hypothesize that these measurements correlate with long-term outcomes allowing individualization of each operation and reduction of adverse effects such as persistent reflux, dysphagia and gas bloat.  Despite being introduced in 2009, there is a paucity of data regarding the standardized usage of EndoFLIP® in the operating room and there is no data regarding its utility in predicting patient outcomes one to two years after surgery. 

Methods: This is a retrospective review of a prospectively maintained quality database. One-hundred seventy-five patients underwent laparoscopic hiatal hernia repair and fundoplication.  The EndoFLIP® was used to measure minimum diameter (Dmin), balloon pressure and distensibility index (DI) at different timepoints throughout the operation.  Post-operative Reflux Severity Index (RSI), Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and Dysphagia Scores were compared to final measurements using a Spearman’s rank correlation coefficient.  Paired t-test was used to evaluate changes over the course of the operation.

Results: Crural closure and fundoplication resulted in significant increase in balloon pressure and decrease in DI when compared to initial measurements as well as measurements taken after hernia reduction. 

  Initial (P) Post-reduction (P) Final
Diameter (mm) 8.6 (0.344) 9.5 (0.614) 8.7
Pressure (mmHg) 28.6 (0.037) 26.9 (0.027) 36.3
Distensibility (mm2/mmHg) 2.6 (0.033) 3.0 (0.047) 1.9

 *P-value calculated based on comparison with final measurements.

After one year, patients who had a larger decrease in post-operative distensibility had lower GERD-HRQL and RSI scores, but at the expense of slightly more dysphagia.  After two years, a final balloon pressure > 25 mmHg or DI < 2.0 mm2/mmHg was significantly associated with a higher likelihood of daily gas bloat (34.5% vs 6.7% and 43.8% vs 12.0%, respectively; P < 0.05).  

Conclusion: The goal of anti-reflux surgery is to re-create a mechanical valve that prevents reflux of gastric contents while also allowing for easy swallowing and intermittent gastric venting. We show that the EndoFLIP® can be a useful adjunct in the operating room to calibrate crural closure and fundoplication to achieve this goal.  Additionally, we demonstrate that post-operative measurements can be used to predict outcomes up to 2 years after surgery.   


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95447

Program Number: S042

Presentation Session: Foregut II – Physiology

Presentation Type: Podium

50

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