• J. Am. Coll. Surg. · Mar 2021

    Novel Interdisciplinary Approach to GERD: Concomitant Laparoscopic Hiatal Hernia Repair with Transoral Incisionless Fundoplication.

    • Alyssa Y Choi, Mary Kathryn Roccato, Jason B Samarasena, Jennifer M Kolb, David P Lee, Robert H Lee, Shaun Daly, Marcelo W Hinojosa, Brian R Smith, Ninh T Nguyen, and Kenneth J Chang.
    • HH Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA; Departments of Medicine, University of California, Irvine Medical Center, Orange, CA. Electronic address: alyssayc@hs.uci.edu.
    • J. Am. Coll. Surg. 2021 Mar 1; 232 (3): 309-318.

    BackgroundTransoral incisionless fundoplication (TIF) is an endoscopic alternative for the treatment of GERD. However, TIF does not address the hiatal hernia (HH). We present a novel approach with a laparoscopic HH repair followed by same-session TIF, coined concomitant transoral incisionless fundoplication (cTIF). The aim of this study was to assess the efficacy, safety, and feasibility of cTIF in a collaborative approach between Gastroenterology and surgery.Study DesignPatients with confirmed GERD and >2 cm HH who underwent cTIF between 2018 and 2020 were included. Symptoms were assessed using the Reflux Disease Questionnaire, GERD Health-Related Quality of Life Index, and the Reflux Symptom Index pre and post cTIF. One-way ANOVA and paired samples t-test were used for statistical analysis.ResultsSixty patients underwent cTIF (53% were men, mean age was 59.3 years) with 100% technical success. Mean ± SD HH measurement on endoscopy was 2.9 ± 1.5 cm. Scores on Reflux Disease Questionnaire for symptom frequency and symptom severity improved significantly from before to 6 months after cTIF (17.4 to 4.72; p < 0.01 and 16.7 to 4.56; p < 0.05, respectively). According to the GERD Health-Related Quality of Life Index, significant decreases were seen post cTIF in heartburn (23.26 to 7.37; p < 0.01) and regurgitation (14.26 to 0; p = 0.05). Reflux Symptom Index similarly decreased after cTIF (17.7 to 8.1 post cTIF; p < 0.01). Mean DeMeester score decreased from 43.7 to 4.9 and acid exposure time decreased from 12.7% to 1.28% post cTIF (p = 0.06).ConclusionsWe present a novel multidisciplinary approach to GERD using a combined endoscopic and surgical approach with close collaboration between Gastroenterology and surgery. Our results suggest that cTIF is safe and effective in reducing reflux symptoms in a large spectrum of GERD patients.Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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