Kim Min P, Lichtenberg Zoe K, Nguyen Duc T, Naselsky Warren, Graviss Edward A, Chihara Ray
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA.
Division of Surgery and Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Surg Endosc. 2025 Jul;39(7):4455-4462. doi: 10.1007/s00464-025-11836-9. Epub 2025 Jun 10.
The endoluminal functional lumen imaging probe (EndoFLIP) provides objective data during Toupet fundoplication. However, it remains unknown whether the values obtained during surgery are associated with long-term dysphagia.
We performed a retrospective cohort analysis of patients who underwent Toupet fundoplication with or without hiatal hernia repair between 2017 and 2022 at a single institution. The distensibility index (DI) was recorded with 30 mL in the catheter after fundoplication. The patients were divided into three groups: Group 1 (DI < 1.5), Group 2 (DI 1.5-2.0), and Group 3 (DI > 2.0). We then analyzed the rates of dysphagia one year after surgery among the groups.
A total of 395 patients (median age, 67 years) were predominantly female (69%, n = 273) and mostly white (85%, n = 336). At 5 weeks post-surgery, all groups showed significant improvement in GERD, dysphagia, and bloating symptoms. In patients with a DI between 1.5 and 2, proton pump inhibitor use was significantly less than that in the other groups. At 1 year, dysphagia was significantly higher in the DI < 1.5 group (8.7%, n = 13/150) than in the DI > 2 group (2.7%, n = 4/146, p = 0.04). Multivariate analysis showed that DI < 1.5 was an independent factor associated with long-term dysphagia.
Patients with a distensibility index of < 1.5 were associated with a significantly higher rate of dysphagia at one year. EndoFLIP provides objective data during surgery, which may help predict long-term outcomes of dysphagia. Patients undergoing Toupet fundoplication may benefit from a final DI > 1.5.
腔内功能性管腔成像探头（EndoFLIP）在Toupet胃底折叠术期间可提供客观数据。然而，手术期间获得的值是否与长期吞咽困难相关仍不清楚。
我们对2017年至2022年在单一机构接受或未接受食管裂孔疝修补的Toupet胃底折叠术患者进行了一项回顾性队列分析。胃底折叠术后，在导管中注入30 mL记录扩张指数（DI）。患者分为三组：第1组（DI < 1.5）、第2组（DI 1.5 - 2.0）和第3组（DI > 2.0）。然后我们分析了各组术后一年的吞咽困难发生率。
共有395例患者（中位年龄67岁），以女性为主（69%，n = 273），且大多为白人（85%，n = 336）。术后5周，所有组的胃食管反流病、吞咽困难和腹胀症状均有显著改善。DI在1.5至2之间的患者，质子泵抑制剂的使用显著少于其他组。1年时，DI < 1.5组的吞咽困难发生率（8.7%，n = 13/150）显著高于DI > 2组（2.7%，n = 4/146，p = 0.04）。多因素分析显示，DI < 1.5是与长期吞咽困难相关的独立因素。
扩张指数< 1.5的患者在一年时吞咽困难发生率显著更高。EndoFLIP在手术期间提供客观数据，这可能有助于预测吞咽困难的长期结局。接受Toupet胃底折叠术的患者可能从最终DI > 1.5中获益。
