P2295 - Single Session Combined Laparoscopic Hernia Repair with Transoral Incisionless Fundoplication: Initial Experience from a Single Center

Tabeer Rana, DO¹, Rahul Karna, MD¹, Abhijit Kulkarni, MD¹, Hiran C. Fernando, MBBS^2
1Allegheny Health Network, Pittsburgh, PA; ²Allegheny General Hospital, Pittsburgh, PA

Introduction: Transoral incisionless fundoplication (TIF) is used for surgical management of gastroesophageal reflux disease. It is contraindicated in patients with atypical GERD symptoms, high grade esophagitis, Barrett’s esophagus and large hiatal hernia ( > 2 cm). Single session combined laparoscopic hernia repair followed by TIF (cTIF) is a novel anti-reflux surgery that can be performed in these patients. We performed a retrospective review of the procedure at our institution.

Methods: A retrospective chart review was done of our electronic database to enroll patients who underwent cTIF at our center. Demographics, clinical features, DeMeester score, total acid exposure time and endoscopy findings were recorded. Patients underwent ambulatory pH monitoring, barium esophagogram and esophageal manometry prior to the procedure. Heartburn score, Reflux Symptom Index and Satisfaction with health was recorded pre and post procedure and analyzed.

Results: 10 patients, aged 58.9+/-8.9 years consisting of 6 males were included in the study. Mean BMI was 27.57+/-2.55 kg/m2. 50% patients were smokers and 40% used alcohol actively. All patients had long standing GERD and 30% underwent previous esophageal procedure for Barrett’s esophagus. All patients had hiatal hernia with mean axial length 3.75+/-1.19 cm, while 40% had Barrett’s esophagus on EGD prior to procedure . Hill grade was as follows: I: 10%; III: 20%; IV: 6%; N/A: 10%. Mean DeMeester score was 45.91+/- 13.65 and total acid exposure time 13.86+/- 3.94%. 80% patients used PPI, while 10% used H2 blocker, while one patient wasn’t on any medical therapy due to microscopic colitis. Mean surgical time was 166.6 +/- 22.93 minutes. One patient had glue reaction at the surgical site. One patient was lost to follow up after procedure. 44.4% (4/9) patients used PPI after 3 months of surgery while 22.2% (2/9) were on it at 6 months. Patients were followed after 102 +/-27 days post procedure. A comparative graph showing Heartburn score and reflux symptom index pre and post procedure has been shown in figure 1. 80% (8/10) patients were dissatisfied with quality of life, which improved to 22.2% (2/9) after procedure.

Discussion: Combined TIF is an effective procedure for patients with high grade esophagitis, Barrett’s esophagus and large hiatal hernia ( > 2 cm). Even though our sample size was small, there seems to be a trend in decreased Heartburn score, RSI score and use of PPI. Further, long term data in a larger population is needed to confirm our findings.



Disclosures:


Tabeer Rana, DO¹, Rahul Karna, MD¹, Abhijit Kulkarni, MD¹, Hiran C. Fernando, MBBS². P2295 - Single Session Combined Laparoscopic Hernia Repair with Transoral Incisionless Fundoplication: Initial Experience from a Single Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.