Hoover Wu1,2,3, Mikhail Attaar4,5, Harry J Wong4,5, Michelle Campbell4,5, Kristine Kuchta6, Woody Denham4, John Linn4, Michael B Ujiki4. 1. Department of Surgery, NorthShore University Health System, Evanston, IL, USA. hoover.wu@uchospitals.edu. 2. Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA. hoover.wu@uchospitals.edu. 3. Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA. hoover.wu@uchospitals.edu. 4. Department of Surgery, NorthShore University Health System, Evanston, IL, USA. 5. Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA. 6. NorthShore University Research Institute, Evanston, IL, USA.
Abstract
INTRODUCTION: Functional luminal imaging probe (FLIP) use during laparoscopic fundoplication (LF) for gastroesophageal reflux disease is well described. However, there is a lack of data on FLIP measurements during magnetic sphincter augmentation (MSA). This study aims to report our institutional experience in performing FLIP during MSA and to compare these measurements to those obtained during Nissen and Toupet fundoplication. METHODS AND PROCEDURES: A retrospective review of a prospectively maintained quality database was performed. Patients who underwent MSA or LF and had FLIP measurements between April 2018 and June 2021 were included. FLIP measurements at the gastroesophageal junction (GEJ) were recorded without pneumoperitoneum at 40 mL balloon fill after hernia reduction, cruroplasty, and MSA or fundoplication. Reflux symptom index (RSI), GERD-HRQL, and dysphagia score were collected up to 2 years. Group comparisons were made using two-tailed Wilcoxon rank-sum and χ2 tests, with statistical significance of p < 0.05. RESULTS: Twenty-seven patients underwent MSA and 100 patients underwent LF (66% Toupet, 34% Nissen). Type III hiatal hernia was present in 3.7% of MSA patients versus over 50% for fundoplication patients. Minimum diameter, cross-sectional area, and distensibility index (DI) were lower after MSA device placement compared to Nissen or Toupet fundoplication (p < 0.05). Postoperative follow-up showed no differences in RSI, GERD-HRQL, and dysphagia score between MSA and Nissen fundoplication (p > 0.05). CONCLUSION: Intraoperative impedance planimetry provided objective information regarding the geometry of the GEJ during MSA. The ring of magnetic beads restores the anti-reflux barrier and transiently opens with food bolus and belching. The magnetic force of the beads may explain why the DI after MSA is lower yet postoperative quality of life is no different than Nissen fundoplication.
INTRODUCTION: Functional luminal imaging probe (FLIP) use during laparoscopic fundoplication (LF) for gastroesophageal reflux disease is well described. However, there is a lack of data on FLIP measurements during magnetic sphincter augmentation (MSA). This study aims to report our institutional experience in performing FLIP during MSA and to compare these measurements to those obtained during Nissen and Toupet fundoplication. METHODS AND PROCEDURES: A retrospective review of a prospectively maintained quality database was performed. Patients who underwent MSA or LF and had FLIP measurements between April 2018 and June 2021 were included. FLIP measurements at the gastroesophageal junction (GEJ) were recorded without pneumoperitoneum at 40 mL balloon fill after hernia reduction, cruroplasty, and MSA or fundoplication. Reflux symptom index (RSI), GERD-HRQL, and dysphagia score were collected up to 2 years. Group comparisons were made using two-tailed Wilcoxon rank-sum and χ2 tests, with statistical significance of p < 0.05. RESULTS: Twenty-seven patients underwent MSA and 100 patients underwent LF (66% Toupet, 34% Nissen). Type III hiatal hernia was present in 3.7% of MSA patients versus over 50% for fundoplication patients. Minimum diameter, cross-sectional area, and distensibility index (DI) were lower after MSA device placement compared to Nissen or Toupet fundoplication (p < 0.05). Postoperative follow-up showed no differences in RSI, GERD-HRQL, and dysphagia score between MSA and Nissen fundoplication (p > 0.05). CONCLUSION: Intraoperative impedance planimetry provided objective information regarding the geometry of the GEJ during MSA. The ring of magnetic beads restores the anti-reflux barrier and transiently opens with food bolus and belching. The magnetic force of the beads may explain why the DI after MSA is lower yet postoperative quality of life is no different than Nissen fundoplication.
Authors: Mikhail Attaar; Bailey Su; Harry Wong; Zachary Callahan; Kristine Kuchta; Stephen Stearns; John G Linn; Woody Denham; Stephen P Haggerty; Michael B Ujiki Journal: Surg Endosc Date: 2021-08-31 Impact factor: 3.453
Authors: Robert A Ganz; Christopher J Gostout; Jerry Grudem; William Swanson; Todd Berg; Tom R DeMeester Journal: Gastrointest Endosc Date: 2008-02 Impact factor: 9.427
Authors: Daniel Skubleny; Noah J Switzer; Jerry Dang; Richdeep S Gill; Xinzhe Shi; Christopher de Gara; Daniel W Birch; Clarence Wong; Matthew M Hutter; Shahzeer Karmali Journal: Surg Endosc Date: 2016-12-15 Impact factor: 4.584
Authors: Bailey Su; Zachary M Callahan; Kristine Kuchta; John G Linn; Stephen P Haggerty; Woody Denham; Michael B Ujiki Journal: J Am Coll Surg Date: 2020-02-17 Impact factor: 6.113