Article record

在抗反流手术中，达到生理性扩张性目标常需对标准脚部修补进行修改。

Achieving physiologic distensibility targets frequently requires modification of standard cruroplasty during anti-reflux surgery.

临床研究咽喉科IF 3.3Q1

文献信息

PMID	42806084
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Xavier C Munoz 查看其他 19 位作者 Moustafa Elshafei；Sjaak Pouwels；Sean Lee；Jonathan I Eini；Clare Lee；Ethan Kerendian；Brynne Ichiuji；Simon Akhnoukh；Katherine Cironi；Kimberly P Mihalsky；Joseph J Kuiper；Luke R Putnam；Harry J Wong；Katie M Galvin；Stuart A Abel；Kamran Samakar；Sharon Shiraga；John C Lipham；Caitlin C Houghton
作者单位	The Division of Upper GI and General Surgery at the University of Southern California, Los Angeles, CA, USA. 查看其他 7 条单位信息 Department of General, Abdominal and Tumor Surgery, St. Elisabethen Krankenhaus, Frankfurt am Main, Hessen, Germany.；Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Munster, Germany.；Department of Surgery, Medical School and University Medical Center OWL, Bielefeld University, Campus Hospital Lippe, Detmold, Germany.；Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital Tilburg, Tilburg, The Netherlands.；Department of Surgical Oncology, Transplant- and General Surgery, Medical University of Gdansk, Gdańsk, Poland.；The Division of Upper GI and General Surgery at the University of Southern California, Los Angeles, CA, USA. Caitlin.Houghton@med.usc.edu.；Department of Surgery, Keck School of Medicine of the University of Southern California, 1516 San Pablo Street, Los Angeles, CA, 90033, USA. Caitlin.Houghton@med.usc.edu.
期刊	Surgical endoscopy
SCI 分区	Q1
IF	3.3
研究类型	临床研究 · 临床
所属专科	咽喉科

中文摘要

背景： 术中EndoFLIP可对抗反流手术期间食管胃连接部（EGJ）扩张性进行客观评估，最终扩张性指数（DI）值为2.0-3.5 mm2/mmHg与改善反流控制同时尽量减少吞咽困难和气胀相关。然而，实时达到这些目标所需的手术修改仍定义不清。我们评估了标准化EndoFLIP方案如何改变机器人食管裂孔疝修补术中的术中决策，并确定了哪些手术组成部分对EGJ扩张性影响最大。
方法： 一项前瞻性观察性队列研究连续纳入由单一前肠外科医生（2024年10月至2025年10月）行机器人食管裂孔疝修补术并胃底折叠术或磁性括约肌增强术（MSA）的患者。在无气腹、标准化40 mL充盈下，于解剖后（T1）、脚部修补后（T2）以及胃底折叠术或MSA后（T3）获取EndoFLIP测量值。应用最终DI目标为2.0-3.5 mm2/mmHg；当T2预测最终术后DI超出该范围时，对脚部修补进行修改。
结果： 共纳入40例患者。平均DI从T1时的6.46 ± 3.27 mm2/mmHg降至T2时的2.98 ± 0.97，以及T3时的2.22 ± 0.46。脚部修补占EGJ扩张性术中总降低的82.1%。10例患者（25.0%）需要EndoFLIP引导的脚部修补修改：增加缝线（n=5）、拆除缝线（n=4）以及拆除后重新放置（n=1）。若干修改是在T2值处于名义目标范围内时进行的，以预期胃底折叠术后扩张性进一步降低。
结论： 使用EndoFLIP进行客观生理校准经常改变标准食管裂孔闭合技术，即使在经验丰富者中也是如此。脚部修补而非胃底折叠术占EGJ扩张性术中变化的大部分，并且是最终生理学的主要可修改决定因素。主观校准可能不足以预测最终EGJ扩张性，而生理测量可能是优化抗反流修补所必需的。

英文摘要

BACKGROUND: Intraoperative EndoFLIP provides objective assessment of esophagogastric junction (EGJ) distensibility during anti-reflux surgery, and final distensibility index (DI) values of 2.0-3.5 mm2/mmHg have been associated with improved reflux control while minimizing dysphagia and gas bloat. However, the operative modifications needed to achieve these targets in real time remain poorly defined. We evaluated how a standardized EndoFLIP protocol alters intraoperative decision-making during robotic hiatal hernia repair and identified which operative components most influence EGJ distensibility.
METHODS: A prospective observational cohort study included consecutive patients undergoing robotic hiatal hernia repair with fundoplication or magnetic sphincter augmentation (MSA) by a single foregut surgeon (October 2024-October 2025). EndoFLIP measurements were obtained after dissection (T1), after cruroplasty (T2), and after fundoplication or MSA (T3) at a standardized 40 mL fill without pneumoperitoneum. A target final DI of 2.0-3.5 mm2/mmHg was applied; the cruroplasty was modified when T2 predicted a final post-procedure DI outside this range.
RESULTS: Forty patients were included. Mean DI decreased from 6.46 ± 3.27 mm2/mmHg at T1 to 2.98 ± 0.97 at T2 and 2.22 ± 0.46 at T3. Cruroplasty accounted for 82.1% of the total intraoperative reduction in EGJ distensibility. EndoFLIP-guided cruroplasty modification was required in 10 patients (25.0%): suture addition (n=5), removal (n=4), and removal followed by replacement (n=1). Several modifications were performed despite T2 values within the nominal target range, anticipating further distensibility reduction after fundoplication.
CONCLUSION: Objective physiologic calibration with EndoFLIP frequently altered standard hiatal closure technique, even in experienced hands. The cruroplasty, rather than the fundoplication, accounted for the majority of intraoperative change in EGJ distensibility and was the principal modifiable determinant of final physiology. Subjective calibration may inadequately predict final EGJ distensibility, and physiologic measurement may be necessary to optimize anti-reflux repair.