PD06.01. Physiological Drift Across BMI in EndoFLIP Guided Hiatus Hernia Repair

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ID: 325736
2026
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Ranked #77 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Background EndoFLIP guided calibration of gastrooesophageal junction (GOJ) distensibility during hiatus hernia repair enables tailoring of fundoplication tightness. The influence of body mass index (BMI) on postoperative physiological changes and symptom outcomes remains unclear. This study assessed whether BMI affects postoperative change in GOJ distensibility and symptom burden after EndoFLIP guided fundoplication. Methods A retrospective cohort of 541 patients undergoing hiatus hernia repair with fundoplication (2010-2018) by a single surgeon was analysed. Intraoperative EndoFLIP measurements were taken pre- and post-fundoplication using a 30 mL balloon and 13 mmHg pneumoperitoneum. Fundoplications were calibrated to a target mean distensibility index (DI) of 0.98 ± 2.37 mm2/mmHg at the GOJ. Patients were stratified by BMI into three groups: <25.0 (Normal/Underweight), 25.0-34.9 (Overweight/Obese I), and ≥35.0 kg/m2 (Obese II-III). Intraoperative and 6-month postoperative GOJ DI values were recorded to calculate physiological drift (change in GOJ distensibility over time following surgery). Secondary outcomes included follow-up dysphagia scores and changes in pH and DeMeester scores. Kruskal-Wallis tests compared outcomes across BMI groups. Results Data showed no significant differences in changes in DI across BMI groups (p = 0.593). Follow-up dysphagia scores (p = 0.188), change in pH (p = 0.091), and change in DeMeester scores (p = 0.066) also did not differ significantly. Pairwise comparisons with Bonferroni correction confirmed no significant group differences. Conclusion BMI does not significantly affect physiological drift in GOJ distensibility, symptom burden, or reflux control following EndoFLIP guided hiatus hernia repair. These findings suggest that standard intraoperative DI targets may be appropriate across BMI categories.
Reference Key
openalex_W7203918588 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Jessica Ng, David Mitchell, L. Nathanson, Andrew Nathanson
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.113
URL
https://doi.org/10.1093/dote/doag077.113
Keywords Keywords not found

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