Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA.
Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
Surg Endosc. 2022 Sep;36(9):6801-6808. doi: 10.1007/s00464-021-08966-1. Epub 2022 Jan 11.
Compliance is the ability of a hollow organ to dilate and increase volume with an increase in pressure, an accurate representation of food bolus transit through the gastroesophageal junction (GEJ). Impedance planimetry system can calculate compliance (change in volume over pressure) and distensibility (cross-sectional area over pressure) of the GEJ. We aim to describe the changes in compliance during anti-reflux surgery and hypothesize that compliance is a better predictor of patient outcomes than distensibility (DI).
A review of a prospectively maintained quality database was performed. Patients with FLIP measurements during laparoscopic fundoplication between August 2018 and June 2021 were included. GEJ compliance and DI were measured after hernia reduction, cruroplasty, and fundoplication. Patient-reported outcomes were collected through standardized surveys up to 2 years after surgery. A scatter plot was used to identify a correlation between compliance and DI. Comparisons of measurements between time points were made using paired t-tests. Spearman's correlation coefficients (ρ), Wilcoxon rank-sum, and chi-square tests were used to evaluate associations between measurements and outcomes.
One hundred and forty-four patients underwent laparoscopic fundoplication. Compliance is strongly associated with DI (r = 0.96), and a comparison of measurements showed similar trends at specific time points during the operation. After hernia reduction, compliance at the GEJ was 168 ± 74 mm/mmHg, cruroplasty 79 ± 39 mm/mmHg, and fundoplication 90 ± 33 mm/mmHg (all comparisons p < 0.05). GEJ compliance of 80-92 mm/mmHg after fundoplication was associated with the best patient-reported outcome scores. A compliance of ≤ 79 mm/mmHg had the highest percentage of patients who reported dysphagia.
Compliance and DI are strongly associated displaying the same directional change during anti-reflux surgery. GEJ compliance of 80-92 mm/mmHg revealed the best patient-reported outcome scores, and avoiding a compliance ≤ 79 mm/mmHg may prevent postoperative dysphagia. Therefore, GEJ compliance is an underutilized FLIP measurement warranting further investigation.
顺应性是中空器官在压力增加时扩张和增加体积的能力，这是食物团通过胃食管交界处（GEJ）的准确表示。阻抗平面测量系统可以计算 GEJ 的顺应性（压力下的体积变化）和可扩张性（压力下的横截面积）。我们旨在描述抗反流手术过程中顺应性的变化，并假设顺应性是预测患者预后的更好指标，而不是可扩张性（DI）。
对前瞻性维护的质量数据库进行了回顾。纳入了 2018 年 8 月至 2021 年 6 月期间接受腹腔镜胃底折叠术期间进行 FLIP 测量的患者。在疝修补、环形切开术和胃底折叠术后测量 GEJ 顺应性和 DI。通过标准化调查收集患者术后 2 年内的报告结果。使用散点图来识别顺应性和 DI 之间的相关性。使用配对 t 检验比较不同时间点的测量值。使用 Spearman 相关系数（ρ）、Wilcoxon 秩和检验和卡方检验来评估测量值与结果之间的关联。
144 例患者接受了腹腔镜胃底折叠术。顺应性与 DI 高度相关（r=0.96），并且在手术过程中的特定时间点进行测量比较显示出相似的趋势。疝修补后，GEJ 顺应性为 168±74 mm/mmHg，环形切开术为 79±39 mm/mmHg，胃底折叠术为 90±33 mm/mmHg（所有比较 p<0.05）。胃底折叠术后 80-92 mm/mmHg 的 GEJ 顺应性与最佳患者报告结果评分相关。≤79 mm/mmHg 的顺应性与报告吞咽困难的患者比例最高。
顺应性和 DI 高度相关，在抗反流手术过程中显示出相同的方向性变化。GEJ 顺应性 80-92 mm/mmHg 显示出最佳的患者报告结果评分，避免顺应性≤79 mm/mmHg 可能预防术后吞咽困难。因此，GEJ 顺应性是一个未被充分利用的 FLIP 测量指标，值得进一步研究。
