pH Scores in Hiatal Repair with Transoral Incisionless Fundoplication

Abstract

Background and Objectives:Transoral incisionless fundoplication is an alternative to traditional laparoscopic fundoplications. Recently, hiatal hernia repair combined with transoral incisionless fundoplication has become an accepted modification of the original procedure; however, outcomes information, particularly objective pH monitoring, has been sparse. We retrospectively review the subjective and objective outcomes of transoral incisionless fundoplication combined with hiatal hernia repair.Methods:Ninety-seven consecutive patients presenting for reflux evaluation were reviewed for outcomes after evaluation and treatment. Fifty-five patients proceeded to hiatal hernia repair with transoral incisionless fundoplication. Twenty-nine patients (53%) were found to have matched preoperative and postoperative validated surveys and pH evaluations.Results:There were no serious complications. The mean followup was 296 days (SD, 117 days). The mean Gastroesophageal Reflux Disease Health Related Quality of Life score improved from 33.7 (SD, 22.0) to 9.07 (SD, 13.95), P < .001. The mean Reflux Symptom Index score improved from 20.32 (SD, 13) to 8.07 (SD, 9.77), P < .001. The mean pH score improved from 35.3 (SD, 2.27) to 10.9 (SD, 11.5), P < .001. Twenty-two of the 29 patients were judged to have an intact hiatal repair with transoral incisionless fundoplication (76%). Of the 22 patients with an intact hiatal repair and intact fundoplication, 21 (95%) had normalized their pH exposure.Conclusions:In this retrospective review, hiatal hernia repair combined with transoral incisionless fundoplication significantly improved outcomes in patients with gastroesophageal reflux disease in both subjective Gastroesophageal Reflux Disease Health Related Quality of Life and Reflux Symptom Index measurements as well as in objective pH scores.

Ten Reasons for Laparoendoscopic Repair of Hiatal Hernia

“…Second, this approach has been shown to be effective in normalizing esophageal pH scores. 2 Third, it preserves the angle of His which is an important antireflux mechanism. Fourth, it does not impact the blood supply of the stomach as it does not require division of the short gastric vessels.…”

Clinical efficacy and safety of magnetic sphincter augmentation (MSA) and transoral incisionless fundoplication (TIF2) in refractory gastroesophageal reflux disease (GERD): a systematic review and meta-analysis

“…Our exclusion criteria were as follows: (1) studies that evaluated TIF1 procedure; (2) studies where TIF was performed with concurrent hiatal hernia repair 15 16 17 ; (3) studies where MSA was performed with concurrent hiatal hernia repair 18 19 20 ; (4) studies that did not report on the clinical outcomes of interest; (5) studies performed in the pediatric population (Age < 18 years); and (6) studies not published in English language. In cases of multiple publications from a single research group reporting on the same patient, same cohort and/or overlapping cohorts, data from the most recent and/or most appropriate comprehensive report were retained.…”

The evolution of TIF: transoral incisionless fundoplication

“…For patients that fail to get off of medical therapy after a 6-month trial of increasing medical care, TIF can restore the angle of HIS and improve the LES function necessary to control reflux symptoms, heal esophagitis, and allow discontinuation of medications. Patients that have a hiatus greater than 3 cm in diameter, as measured with a retroflexed endoscope, 109 can undergo laparoscopic HH repair with TIF. The combined laparoscopic and endoscopic approach has fewer and less comprehensive studies to date, but, in available studies, appears to have similar outcomes in symptom control, safety, and normalization of esophageal pH without causing the bloat syndrome side effects that deterred patients from anatomic repair in the past.…”