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Open Access 09-05-2024 | Gastric Fundoplication | 2023 SAGES Oral

Tailoring the wrap: intraoperative functional lumen imaging probe (FLIP) during hiatal hernia repair

Authors: Hemasat Alkhatib, AJ Haas, Ali M. Kara, Clara Lai, Alejandro Feria, Sergio Bardaro, Amelia Dorsey, Kevin El-Hayek

Published in: Surgical Endoscopy | Issue 6/2024

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Abstract

Introduction

The introduction of the functional lumen imaging probe (FLIP) has provided objective, real-time feedback on the geometric variations with each component of a hiatal hernia repair (HHR). The utility of this technology in altering intraoperative decision-making has been scarcely reported. Herein, we report a single-center series of intraoperative FLIP during HHR.

Methods

A retrospective review of electronic medical records between 2020 and 2022 was conducted and all patients undergoing non-recurrent HHR with FLIP were queried. Patient and hernia characteristics, intraoperative FLIP values and changes in decision-making, as well as early post-operative outcomes were reported. Both diameter and distensibility index (DI) were measured at 40 ml and 50 ml balloon inflation after hiatal dissection, after hiatal closure, and after fundoplication when indicated.

Results

Thirty-three patients met inclusion criteria. Mean age was 62 ± 14 years and mean BMI was 28 ± 6 kg/m2. The majority (53%) were type I hiatal hernias. The largest drop in DI occurred after hiatal closure, with minimal change seen after fundoplication (mean DI of 4.3 ± 2. after completion of HH dissection, vs 2.7 ± 1.2 after hiatal closure and 2.3 ± 1 after fundoplication when performed). In 13 (39%) of cases, FLIP values directly impacted intraoperative decision-making. Fundoplication was deferred in 4/13 (31%) patients, the wrap was loosened in 2/13 (15%); the type of fundoplication was altered to achieve adequate anti-reflux values in 2/13 (15%) patients, and in 1/13 (3%) the wrap was tightened.

Conclusion

FLIP measurements can be used intraoperatively to guide decision-making and alter management plan based on objective values. Long-term outcomes and further prospective studies are required to better delineate the value of this technology.
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Metadata
Title
Tailoring the wrap: intraoperative functional lumen imaging probe (FLIP) during hiatal hernia repair
Authors
Hemasat Alkhatib
AJ Haas
Ali M. Kara
Clara Lai
Alejandro Feria
Sergio Bardaro
Amelia Dorsey
Kevin El-Hayek
Publication date
09-05-2024
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-024-10851-6

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