Division of Endocrine and Minimally Invasive Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, K-836, New York, NY, 10065, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
Surg Endosc. 2022 Jan;36(1):367-374. doi: 10.1007/s00464-021-08291-7. Epub 2021 Jan 25.
We aimed to quantify the contribution of pneumoperitoneum on compliance of the esophagogastric junction (EGJ) during anti-reflux surgery.
Compliance of the EGJ is reduced with anti-reflux surgery. EndoFLIP® planimetry can be used to assess dynamic changes of EGJ compliance intraoperatively. It is unclear how pneumoperitoneum impacts intraoperative measurements by EndoFLIP® and the implications thereof on validity of the results. Therefore, determining variability in EndoFLIP® measurements based on pneumoperitoneum is warranted to establish guidelines to interpret clinical outcomes.
Primary anti-reflux surgery was performed on 39 consecutive patients with pathologic reflux. Intraoperative EGJ measurements including distensibility index (DI), cross-sectional area (CSA), and intrabag pressure were collected using EndoFLIP® at 0, 10, and 15 mmHg of intraperitoneal pressure. Data were acquired pre-procedure, post-hiatal hernia repair, and post-LES augmentation with fundoplications.
Patients underwent Nissen (13.2%), Toupet (68.4%), LINX (10.5%), or Hill-fundoplications (7.9%). There was no difference between 0 and 10 mmHg of pneumoperitoneum in CSA, pressure, or DI measurements pre-procedure; however, there was a difference between 0 and 15 mmHg in pressure (p = 0.016) and DI (p = 0.023) measurements. After LES augmentation, 10 mmHg intraperitoneal pressure reduced DI, though the absolute difference is small (2.0 vs. 1.5 mm/mmHg, p = 0.002).
Pneumoperitoneum affected EGJ distensibility at 15 mmHg, but not 10 mmHg, of insufflation prior to anti-reflux procedures. After anti-reflux surgery, there was a significant variance between 0 and 10 mmHg of pneumoperitoneum in pressure and distensibility. The change in pressure appears linear and needs to be considered if procedural modifications are performed based on intraoperative findings and when evaluating clinical outcomes.
我们旨在量化气腹对反流手术中食管胃交界（EGJ）顺应性的影响。
抗反流手术后 EGJ 的顺应性降低。EndoFLIP® 平面测量法可用于术中评估 EGJ 顺应性的动态变化。目前尚不清楚气腹如何影响 EndoFLIP® 的术中测量值，以及这对结果的有效性有何影响。因此，有必要确定基于气腹的 EndoFLIP® 测量值的变异性，以制定解释临床结果的指南。
对 39 例病理反流患者进行了原发性抗反流手术。在 0、10 和 15mmHg 腹腔内压力下，使用 EndoFLIP® 收集 EGJ 测量值，包括可扩展性指数（DI）、横截面积（CSA）和袋内压力。数据在术前、疝修补术后和 LES 增强（带或不带 fundoplications）后采集。
患者接受了 Nissen（13.2%）、Toupet（68.4%）、LINX（10.5%）或 Hill-fundoplications（7.9%）。在术前，气腹压力为 0 和 10mmHg 时 CSA、压力或 DI 测量值无差异，但在 0 和 15mmHg 时压力（p=0.016）和 DI（p=0.023）测量值有差异。在 LES 增强后，10mmHg 气腹降低了 DI，但绝对差异较小（2.0 与 1.5mm/mmHg，p=0.002）。
在进行抗反流手术之前，气腹在 15mmHg 时影响 EGJ 的可扩展性，但在 10mmHg 时不影响。在抗反流手术后，在 0 和 10mmHg 气腹之间，压力和可扩展性存在显著差异。压力的变化似乎呈线性，因此如果根据术中发现和评估临床结果进行手术修改，则需要考虑这一点。
