OUTCOMES OF COMBINED TRANSORAL INCISIONLESS FUNDOPLICATION AND ROBOTIC HIATAL HERNIA REPAIR (CTIF)
Steven M. Elzein*, Victor G. Peña, Sachin Shetty, Maria Corzo, Daniel Tomey, Rodolfo J. Oviedo
Houston Methodist Hospital, Houston, TX
Gastroesophageal reflux disease (GERD) has a prevalence of up to 28% in the United States, making it one of the most common gastrointestinal disorders. While hiatal hernia repair and Nissen or Toupet fundoplication are considered standard of care, combined transoral incisionless fundoplication and hiatal hernia repair (cTIF) has recently been approved in patients with hiatal hernias >2cm . This endoscopic procedure reduces typical side effects of surgical fundoplication including gas bloating, excessive flatulence, and dysphagia. We present the results of an eight-patient case series of cTIF at our institution with follow-up ranging from two months to one year.
Retrospective chart review analysis was carried out on eight patients with medically-refractory GERD undergoing cTIF by a single surgeon at an academic medical center. Data collection included patient demographics, BMI (kg/m2), medical problems, surgical complications, length of stay, readmissions, complications, and outcomes.
The average age of patients undergoing cTIF was 54.5 years old. Average operative time was 2.61 hours, with an average estimated blood loss of 23 mL. Length of stay was one day for all cases, with all patients progressing to a soft diet four weeks following surgery. No perioperative complications were noted during utilization of endoscopic fundoplication technology. Two out of eight patients required a short course of metoclopramide for gastroparesis within one month post-operatively. No structural abnormalities related to fundoplication were noted at standard one-month postoperative upper gastrointestinal series imaging for all patients.
Our results support cTIF as a safe and efficacious treatment option for patients suffering from hiatal hernia and GERD. Further studies are warranted to determine the long-term durability and effectiveness of cTIF for this large patient population.
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