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Is that 'floppy' fundoplication tight enough?

Brexton Turner¹, Melissa Helm¹, Emily Hetzel¹

¹Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Road, HUB 6th Floor, Milwaukee, WI, 53226, USA.

Surgical Endoscopy

|July 10, 2019

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Endoscopic Functional Luminal Imaging Probe (EndoFLIP) measurements during laparoscopic fundoplication correlate with persistent heartburn. Specific changes in GEJ diameter and area indicate a higher likelihood of severe symptoms post-surgery.

Area of Science:

Gastroenterology
Surgical Technology
Medical Devices

Background:

Laparoscopic fundoplication is the standard surgical treatment for refractory gastroesophageal reflux disease (GERD).
Surgeons aim to create an effective anti-reflux valve while avoiding excessive tightness to prevent complications.
The endoscopic functional luminal-imaging probe (EndoFLIP) offers intraoperative assessment of the gastroesophageal junction (GEJ).

Purpose of the Study:

To investigate the association between EndoFLIP measurements and symptomatic outcomes after laparoscopic fundoplication.
To determine if specific intraoperative GEJ parameters predict long-term heartburn severity.

Main Methods:

Retrospective review of prospectively collected data from patients undergoing primary laparoscopic fundoplication (2014-2018).

Keywords:

Distensibility EndoFLIP Fundoplication Gastroesophageal junction Gastroesophageal reflux disease

Related Experiment Videos

Intraoperative GEJ assessment using EndoFLIP, measuring minimum diameter (Dmin), cross-sectional area (CSA), and distensibility at 30 mL volume.

Correlation analysis between EndoFLIP variables and postoperative GERD Health Related Quality of Life (GERD-HRQL) survey results.

Main Results:

Forty-three patients met inclusion criteria for the study.
A decrease in Dmin of ≤0.15 mm and CSA of ≤1.5 mm² during fundoplication was associated with severe heartburn at 6+ months postoperatively.
Receiver operating characteristic (ROC) curves indicated moderate predictive value for these measurements (AUCs ~0.72).

Conclusions:

EndoFLIP assessment of GEJ opening dynamics during fundoplication is linked to postoperative symptomatic outcomes.
Failure of Dmin and CSA to decrease below specific thresholds suggests a potentially inadequate fundoplication, increasing the risk of persistent or recurrent GERD.
These findings highlight the utility of EndoFLIP in optimizing fundoplication technique to improve patient outcomes.