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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

Objective
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.
Methods
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.
Results
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 (6713 vs 7010, p=0.164), BMI (29.34.9 vs 29.84.3, 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.
Table 1.

RSI (0-45)GERD-HRQL (0-50)Dysphagia Score (1-5)
Pre-Operative3 Weeks Post-OpPre-Operative3 Weeks Post-OpPre-Operative3 Weeks Post-Op
Bougie17.2 11.39.6 8.313.5 11.25.2 6.11.3 0.72.0 0.9
FLIP15.2 11.111.3 8.814.0 9.35.9 5.81.3 0.62.3 0.9
p-value0.4020.4690.6040.5830.7500.212

Conclusion
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.


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