ArticleSurgical endoscopy2022
Crural closure, not fundoplication, results in a significant decrease in lower esophageal sphincter distensibility.
Article in Surgical endoscopy, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
6 citing papers in PubMed, 11 citations in OpenAlex.
- Achieving physiologic distensibility targets frequently requires modification of standard cruroplasty during anti-reflux surgery.Surgical endoscopy · 2026Article
- Intraoperative FLIP to guide revisional hiatal hernia repair: early experience and outcomes.Surgical endoscopy · 2026Article
- The relationship between intraoperative EndoFLIP™ distensibility index and manometry lower esophageal sphincter basal mean pressure in patients undergoing anti-reflux surgery.Surgical endoscopy · 2025Article
- Tailoring the wrap: intraoperative functional lumen imaging probe (FLIP) during hiatal hernia repair.Surgical endoscopy · 2024Article
- Target distensibility index on impedance planimetry during fundoplication by choice of wrap and choice of bougie.Surgical endoscopy · 2023Article
- Impedance planimetry (EndoFLIP™) after magnetic sphincter augmentation (LINX®) compared to fundoplication.Surgical endoscopy · 2022Article
Corrections and comments
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe esophagogastric junction (EGJ) is a complex anti-reflux barrier whose integrity relies on both the intrinsic lower esophageal sphincter (LES) and extrinsic crural diaphragm. During hiatal hernia repair, it is unclear whether the crural closure or the fundoplication is more important to restore the anti-reflux barrier. The objective of this study is to analyze changes in LES minimum diameter (D
methodsFollowing implementation of a standardized operative FLIP protocol, all data were collected prospectively and entered into a quality database. This data were reviewed retrospectively for all patients undergoing hiatal hernia repair. FLIP measurements were collected prior to hernia dissection, after hernia reduction, after cruroplasty, and after fundoplication. Additionally, subjective assessment of the tightness of crural closure was rated by the primary surgeon on a scale of 1 to 5, 1 being the loosest and 5 being the tightest.
resultsBetween August 2018 and February 2020, 97 hiatal hernia repairs were performed by a single surgeon. FLIP measurements collected using a 40-mL volume fill without pneumoperitoneum demonstrated a significant decrease in LES D
conclusionCruroplasty results in a significant decrease in LES distensibility and may be more important than fundoplication in restoring EGJ competency. Additionally, subjective estimation of crural tightness correlates well with objective FLIP evaluation, suggesting surgeon assessment of cruroplasty is reliable.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.