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Short-term outcome of routine use of EndoFLIP during hiatal hernia repair

  • 2020 SAGES Oral
  • Published:
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Abstract

Background

Endoluminal functional lumen imaging probe (EndoFLIP) technology is a tool that can be used to provide intraoperative objective real-time feedback during hiatal hernia repair. We wanted to determine the implication of initial distensibility index (DI) after mobilization of hiatus and final DI after creation of barrier in short-term clinical outcomes.

Methods

We performed a retrospective analysis of prospectively collected data on the intraoperative use of EndoFLIP during hiatal hernia repair at a single institution from 2017 to 2019. We analyzed the initial DI and final DI with the short-term clinical outcomes.

Results

There were 163 patients who had Nissen (n = 16), Toupet (n = 79) or magnetic sphincter augmentation (n = 68) with (n = 158) or without (n = 5) hiatal hernia repair with median initial DI was 3.2 mm2/mmHg. We used 3 mm2/mmHg as the cutoff for low (n = 84) vs. high (n = 79) initial DI group. There was no difference in DeMeester score (p = 0.76), the peristalsis on manometry (p = 0.13), type of hiatal hernia (p = 0.98), and GERD-HRQL score prior to surgery (p = 0.73) between the groups. There was significantly higher final DI in the high initial DI group compared to low initial DI group; however, there was no significant difference in the GERD-HRQL score at 1–3 months (p = 0.28). All of the patients had a final DI > 0.5 mm2/mmHg at the end of the case with median final DI of 1.6 mm2/mmHg. None of these patients required steroids (0%) and only one patient (0.6%) required EGD and dilatation as well as re-operation for dysphagia within 3 months.

Conclusions

The initial DI was associated with final DI, but it did not correlate with improvement in short-term GERD-HRQL score. Final DI maintained above the cutoff value led to most of the patients not to require intervention for dysphagia. Use of the EndoFLIP can provide objective data during the operation and prevent severe dysphagia after repair.

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Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA

    Ugoeze Nwokedi, Leonora M. Meisenbach, Ray Chihara, Edward Y. Chan & Min P. Kim

  2. Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA

    Ugoeze Nwokedi, Leonora M. Meisenbach, Ray Chihara, Edward Y. Chan & Min P. Kim

  3. Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA

    Duc T. Nguyen & Edward A. Graviss

  4. Department of Surgery, Houston Methodist Hospital, Houston, TX, USA

    Edward A. Graviss

Authors
  1. Ugoeze Nwokedi
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  2. Duc T. Nguyen
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  3. Leonora M. Meisenbach
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  4. Ray Chihara
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  5. Edward Y. Chan
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  7. Min P. Kim
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Correspondence to Min P. Kim.

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Disclosures

Min P Kim is consultant for Veran, Intuitive Surgical and Medtronic. Edward Chan is consultant for Veran. Ugoeze Nwokedi, Duc T. Nguyen, Leonora M. Meisenbach, Ray Chihara and Edward A. Graviss does not have any conflicts of interest or financial ties to disclose.

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Nwokedi, U., Nguyen, D.T., Meisenbach, L.M. et al. Short-term outcome of routine use of EndoFLIP during hiatal hernia repair. Surg Endosc 35, 3840–3849 (2021). https://doi.org/10.1007/s00464-020-07788-x

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  • DOI: https://doi.org/10.1007/s00464-020-07788-x

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