Faculty Collaboration Database

Is that 'floppy' fundoplication tight enough? Surg Endosc 2020 Apr;34(4):1823-1828

Date

07/10/2019

Pubmed ID

31286255

DOI

10.1007/s00464-019-06947-z

Scopus ID

2-s2.0-85068863289 (requires institutional sign-in at Scopus site)   22 Citations

Abstract

BACKGROUND: Laparoscopic fundoplication is the treatment of choice for medically refractory gastroesophageal reflux disease (GERD). Surgeons seek to create a competent valve at the gastroesophageal junction (GEJ) but are careful to construct a 'floppy' fundoplication that is not too tight to minimize side effects. The endoscopic functional luminal-imaging probe (EndoFLIP®) uses impedance planimetry to assess the GEJ intraoperatively. We sought to determine if EndoFLIP variables are associated with symptomatic outcomes following fundoplication.

METHODS: We conducted a retrospective review of prospectively maintained data on subjects who underwent primary laparoscopic fundoplication at a single institution between 2014 and 2018. All patients met standard indications for antireflux surgery. Minimum diameter (Dmin), cross-sectional area (CSA), intra-bag pressure, and distensibility index of the GEJ were obtained at 30 mL volumes. GERD Health Related Quality of Life (GERD-HRQL) surveys were administered pre- and postoperatively. Patients were excluded if they underwent fundoplication without EndoFLIP assessment or if they did not complete a postop GERD-HRQL survey. Receiver operating characteristic curves were used to determine if EndoFLIP measurements were correlated with symptomatic outcomes.

RESULTS: Forty-three patients met inclusion criteria. The change in Dmin and CSA measures during fundoplication were associated with daily or more frequent heartburn at 6 or more months postop. A decrease in Dmin of 0.15 mm or less (AUC = 0.718, sensitivity: 71%, specificity: 69%) and a decrease in CSA of 1.5 mm² or less (AUC = 0.728, sensitivity: 71%, specificity: 70%) were associated with severe heartburn.

CONCLUSIONS: GEJ opening dynamics attained by EndoFLIP appear to be associated with symptomatic outcomes. When the Dmin and CSA do not decrease by a defined threshold, heartburn is more likely to be severe at 6 or more months postoperatively. This suggests that the fundoplication may not be tight enough to prevent persistent or recurrent GERD.

Author List

Turner B, Helm M, Hetzel E, Gould JC

Author

Jon Gould MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Esophagogastric Junction
Female
Fundoplication
Gastroesophageal Reflux
Heartburn
Humans
Laparoscopy
Male
Middle Aged
Quality of Life
Retrospective Studies