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. 2019 Jan-Mar;23(1):e2018.00087.
doi: 10.4293/JSLS.2018.00087.

pH Scores in Hiatal Repair with Transoral Incisionless Fundoplication

Glenn Michael Ihde 2nd  1 , Catalina Pena  1 , Christy Scitern  1 , Steve Brewer  1
Affiliations

pH Scores in Hiatal Repair with Transoral Incisionless Fundoplication

Glenn Michael Ihde 2nd et al. JSLS. 2019 Jan-Mar.

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.

Keywords: Gastroesophageal reflux disease (GERD); Hiatal hernia; Reflux; TIF 2.0; Transoral incisionless fundoplication; pH study.

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Conflict of interest statement

Conflicts of Interest: All authors declare no conflict of interest regarding the publication of this article.

Figures

Figure 1.
Figure 1.
GERD diagnosis decision tree.
Figure 2.
Figure 2.
Endoscope used to measure hiatus.
Figure 3.
Figure 3.
Immediate Post TIF 2.0 procedure.
Figure 4.
Figure 4.
Recurrent Hiatal Hernia.
Figure 5.
Figure 5.
Failed TIF 2.0 fundoplication.
Figure 6.
Figure 6.
Normal Anatomy.
Figure 7.
Figure 7.
TIF 2.0 restores normal anatomy.
See this image and copyright information in PMC

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