Collaboration between GI surgery & Gastroenterology improves understanding of the optimal antireflux valve-the omega flap valve.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a chronic and sometimes disabling disease. An important component in the surgical management of GERD is either laparoscopic or endoscopic restoration of the native gastroesophageal flap valve (GEFV). Recently, a procedure combining laparoscopic hiatal hernia repair with transoral incisionless fundoplication (cTIF) was introduced. This relatively new operation is performed in collaboration between the gastrointestinal (GI) surgeon and the gastroenterologist. METHODS: By working together, both interventionalists gain new insight into the ideal GEFV by observing the same operation being performed from different perspectives. In the cTIF, the gastroenterologist learns from an external perspective, through the laparoscopic view, the importance of the crura in contributing to the antireflux barrier. Similarly, the GI surgeon gains understanding of the elements that define an effective and desirable GEFV through an endoscopic perspective. RESULTS: This collaboration with cTIF and seeing the procedure from different perspectives have led to our improved understanding of 1) factors contributing to an optimal surgically constructed GEFV and 2) the limitations of the GEFV constructed by the conventional laparoscopic total and partial fundoplications. CONCLUSION: The collaboration between GI surgery and gastroenterology with cTIF has led to an improved understanding in characteristics of an optimal antireflux barrier and allowed for a proposed technical modification of the current fundoplication technique to optimize the construct of the surgical GEFV.