Comparing Short-Term Patient Outcomes After Fundoplication Performed Over A Traditional Bougie Versus A Functional Lumen Imaging Probe
*Bailey Su, *Mikhail Attaar, *Harry Wong, *Kristine Kuchta, John G Linn, *Stephen P. Haggerty, *Woody Denham, Michael B. Ujiki
NorthShore University Health System, Evanston, IL
Traditionally, fundoplication during anti-reflux surgery or paraesophageal hernia repair has been performed over a firm, plastic bougie. The Endoluminal Functional Lumen Imaging Probe (FLIP) is a balloon-based catheter that can be used in place of a traditional bougie during fundoplication. While the reported rate of bougie complications ranges from 0.5-1.0%, there have been zero complications reported while using the FLIP during fundoplication. Our goal was to demonstrate that short-term outcomes after fundoplication over a FLIP balloon are non-inferior to fundoplication over a traditional bougie, and that the rates of complication from FLIP usage are lower than those of a traditional bougie.
This is a retrospective review of a prospectively maintained quality database at a single center. Three-week post-operative Reflux Severity Index (RSI), Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and Dysphagia Scores were compared between patients undergoing fundoplication over a traditional bougie versus fundoplication over the FLIP balloon. Chi-square, Wilcoxon rank-sum and t-tests were used for statistical analysis.
Between 2008 and 2019, 423 fundoplications were performed over a bougie while 52 fundoplications were performed over a FLIP balloon. There was no significant difference between age (67±13 vs 70±10, p=0.164), BMI (29.3±4.9 vs 29.8±4.3, p=0.618) or gender (73.3% female vs 65.4% female, p=0.229) between the two groups. There were more Nissen fundoplications performed in the Bougie group (78.3% vs 30.8%) and more Toupet fundoplications performed in the FLIP group (69.2% vs 21.8%, p<0.001). At three weeks post-op, there were no significant differences between RSI, GERD-HRQL or Dysphagia Scores between the two groups (Table 1). The rate of bougie-related injuries in the bougie group was 2.1% (9/423) versus 0% (0/52) for the FLIP group.
|RSI (0-45)||GERD-HRQL (0-50)||Dysphagia Score (1-5)|
|Pre-Operative||3 Weeks Post-Op||Pre-Operative||3 Weeks Post-Op||Pre-Operative||3 Weeks Post-Op|
|Bougie||17.2 ± 11.3||9.6 ± 8.3||13.5 ± 11.2||5.2 ± 6.1||1.3 ± 0.7||2.0 ± 0.9|
|FLIP||15.2 ± 11.1||11.3 ± 8.8||14.0 ± 9.3||5.9 ± 5.8||1.3 ± 0.6||2.3 ± 0.9|
Patients undergoing fundoplication over a FLIP balloon reported comparable short-term outcomes compared to those undergoing fundoplication over a traditional bougie. The rate of complication while using the FLIP is lower than a bougie and may be preferable for fundoplication creation.
Back to 2020 Abstracts