INTRODUCTION The purpose of this study is to evaluate the utility of using a functional lumen imaging probe (EndoFLIP™) intra-operatively during hiatal hernia repair and fundoplication. Additionally, we hypothesize that these measurements correlate with long-term outcomes. METHODS A prospectively maintained quality database was queried. Between 2013 and 2018, 175 patients underwent laparoscopic fundoplication, the majority of which also had a hiatal hernia repair. The EndoFLIP™ was used to measure minimum diameter (Dmin), balloon pressure, and distensibility index (DI) at different timepoints throughout the operation. Clinical outcomes were measured up to 2 years after treatment. RESULTS Crural closure and fundoplication resulted in a significant increase in balloon pressure and decrease in DI when compared to initial measurements as well as measurements taken after hernia reduction. After 1 year, patients with a final DI < 2.0 mm2/mmHg reported significantly more gas bloat and dysphagia than those with a final DI ≥ 2.0 mm2/mmHg (p = 0.040 and p = 0.025, respectively). This disparity became even more dramatic at 2 years (p = 0.006 and p = 0.004, respectively), with a final DI < 2.0 mm2/mmHg being significantly associated with higher prevalence of daily gas bloat (43.8% vs. 12.0%; p = 0.03). Additionally, patients with a final DI between 2.0 and 3.5 mm2/mmHg reported significantly lower Reflux Symptom Index scores at one year compared to those with a final DI < 2.0 or > 3.5 mm2/mmHg (p = 0.042). CONCLUSION EndoFLIP™ measurements correlate well with patient outcomes, with a final DI between 2 and 3.5 mm2/mmHg potentially being ideal. The EndoFLIP™ can be a useful adjunct in the operating room by providing objective measurements of esophageal distensibility after crural closure and fundoplication.

中文翻译：

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在手术室使用阻抗平面测量 (EndoFLIP™) 来评估胃食管交界处的扩张性并预测胃底折叠术后的患者结果。

简介 本研究的目的是评估在裂孔疝修复和胃底折叠术中术中使用功能性管腔成像探头 (EndoFLIP™) 的效用。此外，我们假设这些测量与长期结果相关。方法 查询一个前瞻性维护的质量数据库。2013 年至 2018 年间，175 名患者接受了腹腔镜胃底折叠术，其中大多数还进行了裂孔疝修补术。EndoFLIP™ 用于测量整个手术过程中不同时间点的最小直径 (Dmin)、球囊压力和扩张指数 (DI)。临床结果在治疗后长达 2 年进行测量。结果 与初始测量以及疝缩小后的测量相比，小腿闭合和胃底折叠术导致球囊压力显着增加和 DI 降低。1 年后，最终 DI < 2.0 mm2/mmHg 的患者报告的胀气和吞咽困难明显多于最终 DI ≥ 2.0 mm2/mmHg 的患者（分别为 p = 0.040 和 p = 0.025）。这种差异在 2 年时变得更加显着（分别为 p = 0.006 和 p = 0.004），最终 DI < 2.0 mm2/mmHg 与每日胀气的较高患病率显着相关（43.8% 对 12.0%；p = 0.03)。此外，与最终 DI < 2.0 或 > 3.5 mm2/mmHg 的患者相比，最终 DI 在 2.0 和 3.5 mm2/mmHg 之间的患者在一年内报告的反流症状指数评分显着降低（p = 0.042）。结论 EndoFLIP™ 测量结果与患者预后良好相关，最终 DI 介于 2 和 3.5 mm2/mmHg 之间可能是理想的。EndoFLIP™ 可以作为手术室有用的辅助工具，通过在脚闭合和胃底折叠后提供食管扩张性的客观测量。