13.10.2021 | SSAT Plenary Presentation
Impedance Planimetry (Endoflip™) Shows That Length of Narrowing After Fundoplication Does Not Impact Dysphagia
Hoover Wu, Mikhail Attaar, Harry J. Wong, Michelle Campbell, Kristine Kuchta, Woody Denham, Michael B. Ujiki
Journal of Gastrointestinal Surgery
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A short floppy fundoplication has been the surgical dogma to prevent dysphagia and gas-bloat after laparoscopic fundoplication while adequately addressing gastroesophageal reflux disease. The literature on the ideal length of narrowing (LON) of the gastroesophageal junction after fundoplication is sparse. The functional luminal imaging probe (FLIP) can be used during anti-reflux surgery to produce a visual representation of the LON. We hypothesize that a longer LON provides relief of GERD symptoms, however worse dysphagia and gas-bloat.
Methods and Procedures
Prospectively collected data was analyzed. Patients with FLIP measurements during laparoscopic fundoplication between August 2018 and December 2020 were included. FLIP measurements at the gastroesophageal junction were recorded without pneumoperitoneum at 40-mL balloon fill after fundoplication. Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease-Health Related Quality of Life Questionnaire (GERD-HRQL), gas-bloat score, and Dysphagia Score were collected. Comparisons were made using Spearman correlation coefficients (r) and two-tailed Wilcoxon rank-sum tests, with statistical significance set at p < 0.05.
One hundred and eleven patients underwent laparoscopic fundoplication (26% Nissen, 74% Toupet) and had FLIP measurements. Mean LON in this cohort was 2.7 ± 0.8 cm and mean DI was 3.5 ± 1.3 mm2/mmHg. LON is inversely associated with RSI (r = − 0.29, p = 0.04) and gas-bloat (r = − 0.30, p = 0.04). There was no association with Dysphagia Score. Patients with a LON of 2.5–4.5 cm and DI of 2.5–3.6 mm2/mmHg after fundoplication reported lower RSI (p = 0.03) and GERD-HRQL (p = 0.04) compared to patients outside of these ranges. There were no significant differences in patient-reported dysphagia or gas-bloat scores at 1 year between these groups.
Impedance planimetry provides objective real-time measurements and images during anti-reflux surgery, which allows surgeons to measure the length of narrowing after fundoplication. A LON of 2.5–4.5 cm and DI of 2.5–3.6 mm2/mmHg after fundoplication led to better postoperative quality of life at 1 year without an increase in postoperative dysphagia or gas-bloat.