SMART VERSUS STANDARD BOUGIE IN LAPAROSCOPIC HIATAL HERNIA REPAIR: USING IMPEDANCE PLANIMETRY IN THE OPERATING ROOM
Ryan Y. Rhie*, Thomas Coleman, Conner Hughey, Jessica Mcclain, Jacob R. Moremen
Surgery, University of Mississippi Medical Center, Jackson, MS
Introduction
The purpose of this study is to evaluate the utility of using a functional lumen imaging probe (FLIP) intra-operatively during hiatal hernia repair and fundoplication as a "smart bougie" compared with standard techniques.
Methods
A prospectively maintained quality database was queried. Between January 2021 and October 2022, 45 patients underwent laparoscopic fundoplication and hiatal hernia repair. Patient pre-operative and post-operative reflux and disrupted swallowing symptoms were assessed using validated NIH GI-PROMIS surveys. By provider preference, either standard 54-60 French bougie (n=19) or the FLIP (n=26) were used to facilitate cruroplasty and fundoplication. FLIP measurements included minimum diameter (Dmin) and distensibility index (DI) per previously published protocol. Outcomes were measured up to 1 year after treatment.
Results
Both pre-operative and post-operative GI-PROMIS scores were available for 30 (67%) of patients at a median of 6 (3-12) months. There were no significant differences in demographics between the bougie and FLIP groups, and there was not a statistical difference in types of fundoplication performed. Preoperative motility was not reported. Reflux scores improved significantly in all patients from baseline (mean change -8.2 +/- 13.1, p=0.003). Symptom improvement was statistically similar: -12.5 +/- 14.5 percentile points in the bougie group compared to -6.1 +/- 12.3 points in the FLIP group (p=0.232). Dysphagia symptoms also improved significantly from preoperative baseline (mean change -6.2 +/-10.3, p=0.008) overall. However, the improvement in dysphagia was more statistically significant (-13.9 +/- 9.3, p=0.004) in the bougie group than in the FLIP group (-2.3 +/- 10.3, p=0.312) (p=0.006 for difference). Post-fundoplication Dmin and DI (measured as either raw values or as percent change from baseline) were not significantly correlated with postoperative reflux or dysphagia scores.
Conclusion
Hiatal hernia repairs performed with bougie performed slightly above, though not statistically better than FLIP "smart bougie" in controlling reflux without causing dysphagia. FLIP can be a useful adjunct in the operating room by providing objective measurements of esophageal distensibility after crural closure and fundoplication.
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