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Impedance planimetry (EndoFLIPTM) and surgical outcomes after Hill compared to Toupet fundoplication

  • 2023 SAGES Poster
  • Published:
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Abstract

Introduction

Endoluminal functional lumen imaging probe (EndoFLIP) provides a real-time assessment of gastroesophageal junction (GEJ) compliance during fundoplication. Given the limited data on EndoFLIP measurements during the Hill procedure, we investigated the impact of the Hill procedure on GEJ compliance compared to Toupet fundoplication.

Methods

Patients who underwent robotic Hill or Toupet fundoplication with intraoperative EndoFLIP between 2017 and 2022 were included. EndoFLIP measurements of the GEJ included cross sectional surface area (CSA), intra-balloon pressure, high pressure zone length (HPZ), distensibility index (DI), and compliance. Subjective reflux symptoms, gastroesophageal reflux disease-health related quality of life (GERD-HRQL) score, and dysphagia score were assessed pre-operatively as well as at short- and longer-term follow-up.

Results

One-hundred and fifty-four patients (71.9%) had a Toupet fundoplication while sixty (28%) patients underwent the Hill procedure. The CSA [27.7 ± 10.9 mm2 vs 42.2 ± 17.8 mm2, p < 0.0001], pressure [29.5 ± 6.2 mmHg vs 33.9 ± 8.5 mmHg, p = 0.0009], DI [0.9 ± 0.4 mm2/mmHg vs 1.3 ± 0.6 mm2/mmHg, p = 0.001], and compliance [25.9 ± 12.8 mm3/mmHg vs 35.4 ± 13.4 mm3/mmHg, p = 0.01] were lower after the Hill procedure compared to Toupet. However, there was no difference in post-fundoplication HPZ between procedures [Hill: 2.9 ± 0.4 cm, Toupet: 3.1 ± 0.6 cm, p = 0.15]. Follow-up showed no significant differences in GERD-HRQL scores, overall dysphagia scores or atypical symptoms between groups (p > 0.05).

Conclusion

The Hill procedure is as effective to the Toupet fundoplication in surgically treating gastroesophageal reflux disease (GERD) despite the lower CSA, DI, and compliance after the Hill procedure. Both procedures led to DI < 2 mm2/mmHg with no significant differences in dysphagia reporting (12–24) months after the procedure. Further studies to elucidate a cutoff value for DI for postoperative dysphagia development are still warranted.

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Authors and Affiliations

  1. Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68 Street, K-836, New York, NY, 10065, USA

    Hala Al Asadi, Haythem Najah, Jacques A. Greenberg, Teagan Marshall, Niloufar Salehi, Yeon Joo Lee, Maria Cristina Riascos, Brendan M. Finnerty, Thomas J. Fahey III & Rasa Zarnegar

  2. Hospital Israelita Albert Einstein, São Paulo, Brazil

    Rodrigo Edelmuth

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  1. Hala Al Asadi
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  2. Haythem Najah
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  3. Rodrigo Edelmuth
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  4. Jacques A. Greenberg
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  5. Teagan Marshall
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  6. Niloufar Salehi
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Correspondence to Rasa Zarnegar.

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Disclosures

Dr. Rasa Zarnegar works as a consultant for Bard (BD) and Intuitive/Medtronic. Drs. Hala Al Asadi, Haythem Najah, Rodrigo Edelmuth, Jacques A. Greenberg, Teagan Marshall, Niloufar Salehi, Yeon Joo Lee, Maria Cristina Riascos, Brendan M. Finnerty, Thomas J. Fahey III have no conflicts of interest or financial ties to disclose.

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Al Asadi, H., Najah, H., Edelmuth, R. et al. Impedance planimetry (EndoFLIPTM) and surgical outcomes after Hill compared to Toupet fundoplication. Surg Endosc 38, 1020–1028 (2024). https://doi.org/10.1007/s00464-023-10640-7

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  • DOI: https://doi.org/10.1007/s00464-023-10640-7

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