Ideal impedance planimetry (EndoFLIP) distensibility ranges for male and female patients undergoing laparoscopic fundoplication.

Abstract

The distensibility index is the most commonly used impedance planimetry (EndoFLIP) parameter and has been shown to correlate closely with postoperative outcomes. This study aims to compare postoperative outcomes between male and female patients undergoing laparoscopic fundoplication and use them to formulate ideal distensibility index ranges. A prospectively maintained single-institution database was queried for patients undergoing elective laparoscopic fundoplication from 2018 to 2024. Baseline demographics, postoperative outcomes, and quality-of-life outcomes were evaluated. EndoFLIP measurements were correlated to quality-of-life outcomes, and ideal ranges for distensibility index were calculated using a receiver operating characteristic curve analysis. Standard statistical methods were used. A total of 323 patients were identified: 95 male and 228 female. Baseline age was similar (62.0 ± 15.0 vs 65.0 ± 13.0 years, P = .26), but female patients had a higher body mass index (28.2 ± 4.5 vs 29.9 ± 5.7 kg/m², P = .02). Mean postfundoplication distensibility indices were 3.0 ± 1.3 and 2.7 ± 1.2, respectively (P = .31). There was no difference in 30-day readmissions (5.3% vs 6.6%, P = .65) or overall complications (6.3% vs 7.0%, P = .82). At each postoperative time point, dysphagia score, reflux symptom index, and gastroesophageal reflux disease health-related quality-of-life scores were statistically similar for male and female patients (all P > .05). The ideal distensibility indices were 2.4-3.6 mm²/mm Hg for male patients and 2.0-3.6 mm²/mm Hg for female patients. For male and female patients undergoing laparoscopic fundoplication, quality-of-life metrics were similar up to 2 years postoperatively. Although not amenable to direct statistical evaluation, the ideal distensibility index ranges appeared comparable between sexes, which favors a uniform postfundoplication distensibility index.