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