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INTRAOPERATIVE IMPEDANCE PLANIMETRY PROVIDES EXCELLENT OUTCOMES IN PATIENTS PREOPERATIVE MANOMETRY IS OMITTED IN TOUPET FUNDOPLICATION
Timothy Trestrail, Talia R. Arcieri, William Scola
*, Patrick R. Wang, Morgan Shane, Sean Bhalla, Onur C. Kutlu, Mehmet Akcin
General Surgery , University of Miami - Jackson Memorial Hospital, Miami, FL
Introduction: Routine esophageal manometry for surgical planning before paraesophageal hernia (PEH) is utilized to identify esophageal motility defects and to reduce the likelihood of postoperative dysphagia. However, the accuracy is significantly reduced in large hernias. Omission of manometry has been reported in case series due to increased cost, discomfort, and time to procedure. It is also proposed that presence of Los Angeles (LA) grade C and above esophagitis is an indication of abnormal acid exposure which would preclude use of impedance studies. This study investigates the outcomes of impedance planimetry (EndoFLIP) for intraoperative objective real-time feedback for patients with no atypical symptoms and LA grade C and above esophagitis.
Methods: Patients who underwent hiatal hernia repair at a tertiary academic referral center between 2022-2024 were retrospectively reviewed. Patients who did not have pre-operative manometry and underwent hiatal hernia repair with intraoperative EndoFLIP were included in analysis.
Results: 76 patients were included. 54 were female (71.6%). All underwent Toupet fundoplication. Post-wrap esophageal diameter was 13.8 mm (13.2-15.7), and distensibility index (DI) was 3.1 (2.2-4.7). Median hospital stay was 1 day (1-3), there was 1 (0.13%) readmission. 1 (0.13%) patient underwent dilation for dysphagia, 3 (4%) patients reported daily gas bloat which resolved by post-operative week 6. There were no re-operations.
Conclusion: Use of the EndoFLIP can provide quantifiable data during the operation and prevent complications after repair. In patients without pre-operative dysphagia, the routine use of intra-operative EndoFLIP provides valuable information, decreasing costs and patient discomfort with excellent short-term outcomes.
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