Using a standardized intra-operative endoflip protocol during fundoplication to identify factors that affect distensibil
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and Other Interventional Techniques
2020 SAGES ORAL
Using a standardized intra‑operative endoflip protocol during fundoplication to identify factors that affect distensibility Bailey Su1,2 · Mikhail Attaar1,2 · Harry Wong1,2 · Zachary M. Callahan1 · Kristine Kuchta1 · Stephen Stearns1 · John G. Linn1 · Woody Denham1 · Stephen P. Haggerty1 · Michael B. Ujiki1 Received: 8 June 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction The Endoluminal Functional Lumen Imaging Probe (Endoflip) can be used to provide objective measurements of the gastroesophageal junction during fundoplication, and recent publications have suggested that this device could improve surgical outcomes. However, the impact of operative variables has not been clearly reported. The aim of this study is to determine the effect of these variables on functional lumen imaging probe (FLIP) measurements. Methods Following implementation of a standardized operative FLIP protocol, all data were collected prospectively and entered into a quality database. This database was queried for patients undergoing hiatal hernia repair and fundoplication. The protocol utilized various balloon volumes (30 and 40 ml), patient positions (flat and reverse Trendelenburg) and amounts of insufflation (15 mmHg pneumoperitoneum and no pneumoperitoneum). Results Between August 2018 and February 2020, 97 fundoplications were performed by a single surgeon. Multivariable analysis without interactions demonstrated that a 40 ml volume fill resulted in significantly higher minimum diameter (Dmin), cross-sectional area (CSA), intra-balloon pressure (IBP) and distensibility index (DI) compared to a 30 ml volume fill (p
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