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Am J Surg. 2015 Dec;210(6):1018-22; discussion 1022-3. doi: 10.1016/j.amjsurg.2015.06.028. Epub 2015 Sep 14.

A comparison of the endoscopic and laparoscopic view of the gastroesophageal junction in the use of transoral fundoplication.

Author information

  • 1Ihde Surgical Group, PA, 515 W. Mayfield, Suite 402, Arlington, TX 76014, USA. Electronic address:
  • 2Texas Bariatric Specialists, San Antonio, TX, USA.
  • 3The Surgical Clinic of Central Arkansas, Heber Springs, AR, USA.
  • 4Texas Health Physicians Group/Texas Health Presbyterian-Wilson N. Jones Hospital, Sherman, TX, USA.
  • 5North Dallas Surgical Specialists, PA, Garland, TX, USA.
  • 6PA, Granbury, TX, USA.
  • 7North Texas Surgery, Plano, TX, USA.



Endoscopic fundoplication requires accurate evaluation of the gastroesophageal junction (GJ) to determine if hiatal hernia repair is necessary before fundoplication. We compared the endoscopic and laparoscopic evaluations of the GJ.


A total of 53 patients with gastroesophageal reflux disease underwent a laparoscopic repair of a hiatal defect before endoscopic fundoplication. The video of the preoperative endoscopic evaluation was compared with the laparoscopic video (n = 44). Nine patients were excluded because both endoscopic and laparoscopic videos were not available. A 2-tailed paired t test was used to assess the difference between the 2 study groups.


The greatest transverse dimension of the hiatus assessed endoscopically was 3.30 cm ± 1.00 vs 3.88 cm ± 1.03 assessed laparoscopically, P < .001. In 22.8%, the average endoscopic Hill grade was lower than the estimated Hill grade when viewed laparoscopically. In 11.1% (range, 6% to 15%) of cases, the endoscopic view indicated a hiatal hernia repair was unnecessary when the matching laparoscopic view indicated hiatal repair would be needed.


Endoscopic evaluation of the GJ may underestimate the radial size of the hiatal defect.


Endoscopic; Fundoplication; Gastroesophageal reflux disease; Hiatal hernia; Reflux

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