ArticleSurgical endoscopy2026
Use of intraoperative distensibility index with EndoFLIP™ is independently associated with hiatal hernia recurrence after fundoplication.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntraoperative impedance planimetry (EndoFLIP™) provides real-time data that assists hiatal hernia (HH) repairs with fundoplication. An ideal range for the distensibility index (DI) during fundoplication has been previously established to help guide surgeons in performing these cases and is correlated with improved postoperative patient-reported outcomes. However, the correlation between DI and hiatal hernia recurrence remains unknown. This study evaluated the association between final intraoperative DI and postoperative HH recurrence.
methodsPatients undergoing HH repair with fundoplication (2013-2022) were identified from our prospectively maintained institutional database. Patients were stratified by initial HH and fundoplication types. DI was recorded after fundoplication, with the abdomen desufflated, via an 8-cm catheter (EF-325 30 or 40 mL fills) or 16-cm catheter (EF-322 60 mL fill). Outcomes included HH recurrence, 30-day complications, emergency department (ED) visits, reinterventions.
resultsA total of 457 patients were included, of whom 79 (17.3%) developed postoperative HH recurrence. ROC analysis identified an optimal DI cutoff of 3.7 mm
conclusionFinal intraoperative DI ≥ 3.7 mm
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