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Hoffmann H, Glauser P, Adolf D, Kirchhoff P, Köckerling F. Mesh vs. non-mesh repair of type I hiatal hernias: a propensity-score matching analysis of 6533 patients from the Herniamed registry. Hernia 2024; 28:1667-1678. [PMID: 38551794 PMCID: PMC11450037 DOI: 10.1007/s10029-024-03013-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/03/2024] [Indexed: 10/04/2024]
Abstract
INTRODUCTION Surgical treatment of type I hiatal sliding hernias aims to control the gastroesophageal reflux symptoms and prevention of hernia recurrence. Usually, a cruroplasty is performed to narrow the hiatal orifice. Here, it remains controversial if a mesh reinforcement of the cruroplasty should be performed, since benefits as well as mesh-associated complications have been described. METHODS We performed a propensity-score matching analysis with data derived from the Herniamed registry comparing patients undergoing laparoscopic type I hiatal hernia repair with and without synthetic mesh. We analyzed perioperative, intraoperative, and postoperative data including data derived from the 1-year follow-up in the registry. RESULTS 6.533 patients with an axial, type I hiatal hernia and gastroesophageal reflux are included in this analysis. Mesh augmentation of the hiatoplasty was performed in n = 1.252/6.533 (19.2%) of patients. The defect size in the subgroup of patients with mesh augmentation was with mean 16.3 cm2 [14.5; 18.2] significantly larger as in the subgroups without mesh augmentation with 10.8 cm2 [8.7; 12.9]; (p < 0.001). In patients with mesh hiatoplasty n = 479 (38.3%) Nissen and n = 773 (61.7%) Toupet fundoplications are performed. 1.207 matched pairs could be analyzed. The mean defect size after matching was with 15.9 cm2 comparable in both groups. A significant association was seen regarding recurrence (4.72% mesh vs. 7.29% non-mesh hiatoplasty, p = 0.012). The same relation can be seen for pain on exertion (8.78% vs 12.10%; p = 0.014) and pain requiring treatment (6.13% vs 9.11%; p = 0.010). All other outcome parameter showed no significant correlation. CONCLUSIONS Our data demonstrate that mesh-reinforced laparoscopic type I hiatal hernia repair in larger defects is associated with significantly lower rates for recurrence, pain on exertion and pain requiring treatment.
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Affiliation(s)
- H Hoffmann
- ZweiChirurgen GmbH, Center for Hernia Surgery and Proctology, Basel, Switzerland.
- Merian Iselin, Clinic for Orthopedics and Surgery, Basel, Switzerland.
| | - P Glauser
- Solothurn Hospitals, Clinic for Surgery, Dornach, Switzerland
| | - D Adolf
- StatConsult GmbH, Magdeburg, Germany
| | - P Kirchhoff
- ZweiChirurgen GmbH, Center for Hernia Surgery and Proctology, Basel, Switzerland
- Merian Iselin, Clinic for Orthopedics and Surgery, Basel, Switzerland
| | - F Köckerling
- Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charitè University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
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Authors, Collaborators. S2k guideline Gastroesophageal reflux disease and eosinophilic esophagitis of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1786-1852. [PMID: 39389106 DOI: 10.1055/a-2344-6282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
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Aiolfi A, Sozzi A, Bonitta G, Bona D, Bonavina L. Foregut Erosion Related to Biomedical Implants: A Scoping Review. J Laparoendosc Adv Surg Tech A 2024; 34:691-709. [PMID: 39102627 DOI: 10.1089/lap.2024.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
Introduction: Biomedical devices implanted transabdominally have gained popularity over the past 50 years in the treatment of gastroesophageal reflux disease, paraesophageal hiatal hernia, and morbid obesity. Device-related foregut erosions (FEs) represent a challenging event that demands special attention owing to the potential of severe postoperative complications and death. Purpose: The aim was to provide an overview of full-thickness foregut injury leading to erosion associated with four types of biomedical devices. Methods: The study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, EMBASE, and Web of Science databases were queried until December 31, 2023. Eligible studies included all articles reporting data, management, and outcomes on device-related FE. Results: Overall, 132 articless were included for a total of 1292 patients suffering from device-related FE. Four different devices were included: the Angelchik antireflux prosthesis (AAP) (n = 25), nonabsorbable mesh for crural repair (n = 60), adjustable gastric banding (n = 1156), and magnetic sphincter augmentation device (n = 51). The elapsed time from device implant to erosion ranged from 1 to 480 months. Most commonly reported symptoms were dysphagia and epigastric pain, while acute presentation was reported rarely and mainly for gastric banding. The technique for device removal evolved from more invasive open approaches toward minimally invasive and endoscopic techniques. Esophagectomy and gastrectomy were mostly reported for nonabsorbable mesh FE. Overall mortality was .17%. Conclusions: Device-related FE is rare but may occur many years after AAP, nonabsorbable mesh, adjustable gastric banding, and magnetic sphincter augmentation implant. FE-related mortality is infrequent, however, increased postoperative morbidity and the need for esophagogastric resection were observed for nonabsorbable mesh-reinforced cruroplasty.
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Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Andrea Sozzi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
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Analatos A, Håkanson BS, Ansorge C, Lindblad M, Lundell L, Thorell A. Hiatal Hernia Repair With Tension-Free Mesh or Crural Sutures Alone in Antireflux Surgery: A 13-Year Follow-Up of a Randomized Clinical Trial. JAMA Surg 2024; 159:11-18. [PMID: 37819652 PMCID: PMC10568445 DOI: 10.1001/jamasurg.2023.4976] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/26/2023] [Indexed: 10/13/2023]
Abstract
Importance Antireflux surgery is an effective treatment of gastroesophageal reflux disease (GERD), but the durability of concomitant hiatal hernia repair remains challenging. Previous research reported that the use of a mesh-reinforced, tension-free technique was associated with more dysphagia for solid foods after 3 years without reducing hiatal hernia recurrence rates compared with crural sutures alone, but the long-term effects of this technique have not been assessed. Objective To assess the long-term anatomical and functional outcomes of using a mesh for hiatal hernia repair in patients with GERD. Design, Setting, and Participants A double-blind, randomized clinical trial was performed at a single center (Ersta Hospital, Stockholm, Sweden) from January 11, 2006, to December 1, 2010. A total of 159 patients were recruited and randomly assigned. Data for the current analysis were collected from September 1, 2021, to March 31, 2022. All analyses were conducted with the intention-to-treat population. Interventions Closure of the diaphragmatic hiatus with crural sutures alone vs a tension-free technique using a nonabsorbable polytetrafluoroethylene mesh (Bard CruraSoft). Main Outcomes and Measures The primary outcome was radiologically verified recurrent hiatal hernia after more than 10 years. Secondary outcomes were dysphagia scores (ranging from 1 to 4, with 1 indicating no episodes of dysphagia and 4 indicating more than 3 episodes of dysphagia per day) for solid and liquid foods, generic 36-Item Short Form Health Survey and disease-specific Gastrointestinal Symptom Rating Scale symptom assessment scores, proton pump inhibitor consumption, and reoperation rates. Intergroup comparisons of parametric data were performed using t tests; for nonparametric data, Mann-Whitney U, χ2, or Fisher exact tests were used. For intragroup comparisons vs the baseline at follow-up times, the Friedman test was used, and post hoc analysis was performed using Wilcoxon matched pairs. Results Of 145 available patients, follow-up data were obtained from 103 (response rate 71%; mean [SD] age at follow-up, 65 [11.3] years; 55 [53%] female), with 53 initially randomly assigned to mesh reinforcement, and 50 to crural suture alone. The mean (SD) follow-up time was 13 (1.1) years. The verified radiologic hiatal hernia recurrence rates were 11 of 29 (38%) in the mesh group vs 11 of 35 (31%) in the suture group (P = .61). However, 13 years postoperatively, mean (SD) dysphagia scores for solids remained significantly higher in the mesh group (mean [SD], 1.9 [0.7] vs 1.6 [0.9]; P = .01). Conclusions and Relevance Findings from this long-term follow-up of a randomized clinical trial suggest that tension-free crural repair with nonabsorbable mesh does not reduce the incidence of hiatal hernia recurrence 13 years postoperatively. This finding combined with maintained higher dysphagia scores does not support the routine use of tension-free polytetrafluoroethylene mesh closure in laparoscopic hiatal hernia repair for treatment of GERD. Trial Registration ClinicalTrials.gov Identifier: NCT05069493.
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Affiliation(s)
- Apostolos Analatos
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Nyköping Hospital, Nyköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Sweden
| | - Bengt S. Håkanson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery and Anaesthesiology, Ersta Hospital, Stockholm, Sweden
| | - Christoph Ansorge
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Nyköping Hospital, Nyköping, Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Lundell
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Anders Thorell
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery and Anaesthesiology, Ersta Hospital, Stockholm, Sweden
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Autorinnen/Autoren, Collaborators:. S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:862-933. [PMID: 37494073 DOI: 10.1055/a-2060-1069] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
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D'Urbano F, Tamburini N, Resta G, Maniscalco P, Marino S, Anania G. A Narrative Review on Treatment of Giant Hiatal Hernia. J Laparoendosc Adv Surg Tech A 2023; 33:381-388. [PMID: 36927045 DOI: 10.1089/lap.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background: The current gold standard of treatment for giant hiatal hernias (GHHs) is laparoscopic surgery. Laparoscopic surgery was performed as a less invasive procedure for paraesophageal hernias more than 25 years ago. Its viability and safety have almost all been shown. Materials and Methods: A review of recent and current studies' literature was done. Prospective randomized trials, systematic reviews, clinical reviews, and original articles were all investigated. The data were gathered in the form of a narrative evaluation. We examine the state of laparoscopic GHH repair today and outline the GHH management strategy. Results: In this review, we clear up misunderstandings of GHH and address bad habits that may have contributed to poor results, and we have consequently performed a methodical evaluation of GHH. First, we address subcategorizing GHH and provide criteria to define them. The preoperative workup strategies are then discussed, with a focus on any pertinent and frequent atypical symptoms, indications for surgery, timing of surgery, and the importance of surgery. The approach to the techniques and the logic behind surgery are then presented along with some important dissection techniques. Finally, we debate the role of mesh reinforcement and evaluate the data in terms of recurrence, reoperation rate, complications, and delayed stomach emptying. Finally, we suggest a justification for common postoperative investigations. Conclusions: Surgery is the only effective treatment for GHH at the moment. If the right operational therapy principles are applied, this is generally successful. There is a growing interest in laparoscopic paraesophageal hiatal hernia repair as a result of the introduction of laparoscopic antireflux surgery. Today's less invasive procedures provide a better therapeutic choice with a lower risk.
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Affiliation(s)
- Francesco D'Urbano
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Nicola Tamburini
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Giuseppe Resta
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Pio Maniscalco
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Serafino Marino
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Gabriele Anania
- Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
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Grimsley E, Capati A, Saad AR, DuCoin C, Velanovich V. Novel "starburst" mesh configuration for paraesophageal and recurrent hiatal hernia repair: comparison with keyhole mesh configuration. Surg Endosc 2023; 37:2239-2246. [PMID: 35902405 DOI: 10.1007/s00464-022-09447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Controversy exists over the use of mesh, its type and configuration in repair of hiatal hernia. We have used biological mesh for large or recurrent hiatal hernias. We have developed a mesh configuration to better enhance the tensile strength of the hiatus by folding the mesh over the edge of the hiatus-entitled the "starburst" configuration. We report our experience with the starburst configuration, comparing it to our results with the keyhole configuration. METHODS Medical records of all patients undergoing either the keyhole or starburst mesh configuration hiatal hernia repair were reviewed between 2017 and 2021. Data gathered included age, sex, type of hernia (sliding, paraesophageal, or recurrent), fundoplication type (none, Nissen, Toupet, Dor, Collis-Nissen, Collis-Toupet, or magnetic sphincter augmentation [MSA]), 30-day complications, and long-term outcomes (hiatal hernia recurrence, reflux-symptom recurrence, dysphagia, dilations, reoperations). RESULTS From 7/2017 to 8/2019, 51 cases using the keyhole mesh were completed. Sliding hiatal hernia comprised 4%, paraesophageal hernia (PEH) 64% and recurrent hiatal hernia (RHH) 34% of cases. Distribution of fundoplication type: 2% none, 41% Nissen, 41% Toupet, 8% Dor, 2% Collis-Nissen, and 6% Collis-Toupet. 30-day complication rate 31%. Long-term outcomes: recurrent hiatal hernia 16%, dysphagia 12%, dysphagia requiring dilation(s) 10%, recurrent GERD symptoms 4%, and reoperation 14%. From 10/2020 to 8/2021, 58 cases using the starburst configuration were completed. PEH comprised 60% and RHH 40%. Distribution of fundoplication type: 10% none, 40% Nissen, 43% Toupet, 5% MSA, 2% Collis-Toupet. 30-day complication rate 16%. Long-term outcomes: recurrent hiatal hernia 19%, dysphagia 14%, dilations 5%, recurrent GERD symptoms 9%, and reoperations 3%. CONCLUSION The starburst mesh configuration compares favorably with the keyhole configuration with respect to postoperative dysphagia, need for esophageal dilation, and GERD symptom recurrence, with similar recurrence rates. We are continuing to further refine this technique and study the long-term outcomes.
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Affiliation(s)
- Emily Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, MDC 3129, Tampa, FL, 33612, USA.
| | - Ana Capati
- Department of Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, MDC 3129, Tampa, FL, 33612, USA
| | - Adham R Saad
- Department of Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, MDC 3129, Tampa, FL, 33612, USA
| | - Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, MDC 3129, Tampa, FL, 33612, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, MDC 3129, Tampa, FL, 33612, USA
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Grubnik VV, Bereznytskyi YS, Ilyashenko VV, Grubnyk VV, Korchovyi DV, Kiosov OM. Complications, caused by application of the net implants in the hiatal hernias plasty. KLINICHESKAIA KHIRURGIIA 2022. [DOI: 10.26779/2522-1396.2022.3-4.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective. Studying of complications, connected with application of the net implants in patients with large hiatal hernias.
Materials and methods. Retrospective investigation was conducted with objective to study complications, connected with application of the net implants in patients with large hiatal hernias, operated in the clinic during period from 2008 to 2018 yr. Of 1168 patients operated on and suffering gastro-esophageal reflux disease as well as hiatal hernias, 817 have had large hernias. In 353 patients with large hernias for strengthening of cruroraphy sutures the net implants were applied. There were used low-weighted implant-net Ultrapro, the composite net Parietex, self-fixating surgical net ProGrip, absorbable net Vicryl, polytetrafluoroethylene net with nitinol carcass, biological net Bio-A. All the patients symptoms were registered, and the quality of life studied.
Results. Complications, caused by the net implants impact, were revealed in 17 (1.5%) patients. In all 17 patients the esophageal structuring have occurred due to pronounced cicatrization in region of the net implant installation. In 6 patients dysphagia due to the net ingrowth into esophageal tissue was observed, and in 2 – chronic inflammatory process in place of the net installation. One patient have had small esophageal perforation with restricted mediastinitis. In 3 patients, in whom the polytetrafluoroethylene nets were installed, their migration into esophageal lumen was revealed. Reoperations were done in all 17 patients. In 7 patients the net was removed completely. In 1 patient the net was removed and mediastinum drained. In 3 patients, in whom polytetrafluoroethylene nets have migrated into esophageal lumen, they were removed endoscopically with further installation of special stents. Results of reoperations were estimated as good in 15 patients. In 2 patients after reoperations dysphagia was observed, which needed a second time balloon dilatation and installation of stent in 1 of them.
Conclusion. Nonabsorbable nets ought to be applied with high technical accuracy, it is necessary to prevent their contact with the esophagus. Application of the polytetrafluoroethylene nets with nitinol carcass for plasty of large hiatal hernias must be forbidden.
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Angeramo CA, Schlottmann F. Laparoscopic Paraesophageal Hernia Repair: To Mesh or not to Mesh. Systematic Review and Meta-analysis. Ann Surg 2022; 275:67-72. [PMID: 33843796 DOI: 10.1097/sla.0000000000004913] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare outcomes after laparoscopic paraesophageal hernia repair (LPEHR) with mesh or primary repair alone. SUMMARY OF BACKGROUND DATA High recurrence rates after LPEHR have been reported. Whether the use of mesh improves outcomes remains elusive. METHODS A systematic literature search was performed to identify randomized controlled trials (RCTs) comparing LPEHR with mesh repair versus suture repair alone. Early (≤6 months) and late (>6 months) recurrence rates were used as primary endpoints to assess efficacy. Intraoperative complications, overall morbidity, and reoperation rates were used as secondary endpoints to assess safety. A meta-analysis was conducted using relative risks (RR) with 95% confidence intervals (CI) for the analyzed outcomes. RESULTS Seven RCTs comparing mesh (n = 383) versus suture only (n = 352) repair were included for analysis. Patients undergoing LPEHR with mesh reinforcement had similar early (RR = 0.74, 95% CI = 0.26-2.07, P = 0.46) and late (RR = 0.75, 95% CI = 0.27-2.08, P = 0.48) recurrence rates as those with primary repair. Similar recurrence rates were also found when stratifying the analysis by the type of mesh utilized (absorbable and nonabsorbable). Intraoperative complications (RR = 1.03, 95% CI = 0.33-3.28, P = 0.92) and reoperation rates (RR = 0.75, 95% CI = 0.29-1.92, P = 0.45) were also similar in both groups. Overall morbidity, however, was higher after mesh repair with nonabsorbable mesh (RR = 1.45, 95% CI = 1.24-1.71, P < 0.01). CONCLUSIONS Patients undergoing LPEHR have similar early and late recurrence rates with either mesh reinforcement or suture only repair, regardless of the type of mesh utilized. Overall morbidity, however, seems to be higher in patients repaired with nonabsorbable mesh.
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Affiliation(s)
- Laura Mazer
- Department of Surgery, Division of Minimally Invasive Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Dana A Telem
- Department of Surgery, Division of Minimally Invasive Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
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Kuvendjiska J, Höppner J. [Mesh Implantation in Anti-Reflux and Hiatal Hernia Surgery - Contra Statement]. Zentralbl Chir 2021; 146:200-203. [PMID: 33851382 DOI: 10.1055/a-1403-3558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the surgical treatment of gastroesophageal reflux disease and of hiatal hernias, the high rate of recurrence of hiatal hernias is a central problem. Against this background, various, primarily alloplastic, meshes are used to augment suture closure on the esophageal hiatus. Very different results have been reported in the past and the use of meshes in hiatus reconstruction is controversial. In addition to the frequency of recurrences, reports about complications of mesh augmentation are in the foreground. On the basis of several prospective randomised double-blinded comparative studies and meta-analyses (class Ia and Ib evidence), the current data do not show any advantages of mesh-augmented hiatoplasty for the prevention of recurrence of hiatal hernia. At the same time, there exist reports of more long-term postoperative complications, especially dysphagia, after use of meshes for augmentation of hiatus reconstruction. Therefore, routine use of mesh augmentation for hiatus reconstruction is currently not recommended.
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Affiliation(s)
- Jasmina Kuvendjiska
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - Jens Höppner
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland
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12
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Mesh-related complications in paraoesophageal repair: a systematic review. Surg Endosc 2020; 34:4257-4280. [PMID: 32556700 DOI: 10.1007/s00464-020-07723-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/09/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Paraoesophageal hernias (PEH) have a high recurrence rate, prompting surgeons to consider the use of mesh reinforcement of the hiatus. The risks and benefits of mesh augmentation in PEH repair are debated. Mesh-related complications including migration and erosion are considered in this publication. DESIGN A systematic literature review of articles published between 1970 and 2019 in Medline, OVID, Embase, and Springer database was conducted, identifying case reports, case series and observational studies of PEH repair reporting mesh-related complications. RESULTS Thirty-five case reports/series of 74 patients and 20 observational studies reporting 75 of 4200 patients with mesh complications have been included. The incidence of mesh-related erosions in this study is 0.035%. PTFE, ePTFE, composite and synthetic meshes were frequently associated with mesh erosion requiring intervention. Complete erosions are often managed endoscopically while partial erosions may require surgery and resection of the oesophagus and/or stomach. CONCLUSIONS Mesh-related complication is rare with dysphagia a common presenting feature. Mesh erosion is associated with synthetic mesh more frequently in the reported literature. A mesh registry with long-term longitudinal data would help in understanding the true incidence of mesh-related complications.
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Braghetto I, Korn O, Rojas J, Valladares H, Figueroa M. Hiatal hernia repair: prevention of mesh erosion and migration into the esophagogastric junction. ACTA ACUST UNITED AC 2020; 33:e1489. [PMID: 32428134 PMCID: PMC7236328 DOI: 10.1590/0102-672020190001e1489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
Background:
Erosion and migration into the esophagogastric lumen after laparoscopic
hiatal hernia repair with mesh placement has been published. Aim: To present surgical maneuvers that seek to diminish the risk of this
complication. Method: We suggest mobilizing the hernia sac from the mediastinum and taking it down
to the abdominal position with its blood supply intact in order to rotate it
behind and around the abdominal esophagus. The purpose is to cover the
on-lay mesh placed in “U” fashion to reinforce the crus suture. Results: We have performed laparoscopic hiatal hernia repair in 173 patients (total
group). Early postoperative complications were observed in 35 patients
(27.1%) and one patient died (0.7%) due to a massive lung thromboembolism.
One hundred twenty-nine patients were followed-up for a mean of 41+28months.
Mesh placement was performed in 79 of these patients. The remnant sac was
rotated behind the esophagus in order to cover the mesh surface. In this
group, late complications were observed in five patients (2.9%). We have not
observed mesh erosion or migration to the esophagogastric lumen. Conclusion: The proposed technique should be useful for preventing erosion and migration
into the esophagus.
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Affiliation(s)
- Italo Braghetto
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Owen Korn
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jorge Rojas
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Hector Valladares
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Manuel Figueroa
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
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Memon MA, Siddaiah-Subramanya M, Yunus RM, Memon B, Khan S. Suture Cruroplasty Versus Mesh Hiatal Herniorrhaphy for Large Hiatal Hernias (HHs): An Updated Meta-Analysis and Systematic Review of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech 2020; 29:221-232. [PMID: 30855402 DOI: 10.1097/sle.0000000000000655] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND To explore the clinical outcomes, safety and effectiveness of suture cruroplasty versus mesh repair for large hiatal hernias (HHs) by an updated meta-analysis. MATERIAL AND METHODS Randomized controlled trials evaluating the effects of these 2 treatment modalities were searched from PubMed and other electronic databases between January 1991 and July 2018. The outcome variables analyzed included operating time, complications, recurrence of HH or wrap migration, reoperation, hospital stay and quality of life. RESULTS Five randomized controlled trials totaling 478 patients (suture=222, mesh=256) were analyzed. For reoperation variable, the odds ratio was significantly 3.26 times higher for the suture group. For recurrence of HH, the odds ratio for the suture group was nonsignificantly 1.65 times higher compared with the mesh group. Comparable effects were noted for all other variables. CONCLUSIONS Mesh repair seems to be superior to suture cruroplasty for large HH repair. Therefore, the routine use of mesh may be advantageous in selected cases.
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Affiliation(s)
- Muhammed A Memon
- South East Queensland Surgery (SEQS) and Sunnybank Obesity Centre, Sunnybank.,Mayne Medical School, School of Medicine, University of Queensland, Brisbane.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast.,Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK.,International Centre for Applied Climate Sciences and Centre for Health Sciences Research, School of Agricultural, Computing and Environmental Sciences, University of Southern Queensland, Toowoomba, Qld
| | - Manjunath Siddaiah-Subramanya
- Mayne Medical School, School of Medicine, University of Queensland, Brisbane.,Charles Gardiner Hospital, Perth, WA, Australia
| | - Rossita M Yunus
- Institute of Mathematical Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Breda Memon
- South East Queensland Surgery (SEQS) and Sunnybank Obesity Centre, Sunnybank
| | - Shahjahan Khan
- International Centre for Applied Climate Sciences and Centre for Health Sciences Research, School of Agricultural, Computing and Environmental Sciences, University of Southern Queensland, Toowoomba, Qld
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15
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Borman DA, Sunshein KE, Stigall KS, Madabhushi VV, Davenport DL, Plymale MA, Roth JS. Clinical and Quality of Life Assessment of Patients Undergoing Laparoscopic Hiatal Hernia Repair. Am Surg 2019. [DOI: 10.1177/000313481908501135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hiatal hernia repair (HHR) and fundoplication are similarly performed among all hiatal hernia types with similar techniques. This study evaluates the effect of HHR using a standardized technique for cruroplasty with a reinforcing polyglycolic acid and trimethylene carbonate mesh (PGA/TMC) on patient symptoms and outcomes. A retrospective review of patient perioperative characteristics and postoperative outcomes was conducted for cases of laparoscopic hiatal hernia repair (LHHR) using a PGA/TMC mesh performed over 21 months. Gastroesophageal reflux disease symptom questionnaire responses were compared between preoperative and three postoperative time points. Ninety-six patients underwent LHHR with a PGA/TMC mesh. Post-operatively, the number of overall symptoms reported by patients decreased across all postoperative periods ( P < 0.001). Patients reported a significant reduction in antacid use long term ( P < 0.001). Laryngeal and regurgitation symptoms decreased at all time points ( P < 0.05). There was no difference in dysphagia preoperatively and postoperatively at any time point. Individuals undergoing HHR with PGA/TMC mesh experienced improved regurgitation and laryngeal symptoms, and decreased use of antacid medication.
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Affiliation(s)
| | | | - Kyle S. Stigall
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Vashisht V. Madabhushi
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky; and
| | | | - Margaret A. Plymale
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky; and
| | - John Scott Roth
- Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky; and
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17
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Khaled I, Priego P, Faisal M, Cuadrado M, García-Moreno F, Ballestero A, Galindo J, Lobo E. Assessment of short-term outcome with TiO 2 mesh in laparoscopic repair of large paraesophageal hiatal hernias. BMC Surg 2019; 19:156. [PMID: 31660930 PMCID: PMC6816156 DOI: 10.1186/s12893-019-0607-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 09/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic large para-oesophageal hiatal hernia (LPHH) repair using mesh reinforcement significantly reduces postoperative recurrence rates compared to conventional suture repair, especially within short follow-up times. However, the ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. The aim of this study was to survey our short-term results of LPHH management with a biosynthetic monofilament polypropylene mesh coated with titanium dioxide to enhance biocompatibility (TiO2Mesh™). Methods A retrospective study was performed at Ramon y Cajal University Hospital, Spain from December 2014 to October 2018. Data were collected on 27 consecutive patients with extensive hiatal hernia defects greater than 5 cm for which a laparoscopic repair was performed by primary suture and additional reinforcement with a TiO2Mesh™. Study outcomes were investigated, including clinical and radiological recurrences, dysphagia and mesh-related drawbacks. Results Twenty-seven patients were included in our analysis; 10 patients were male, and 17 were female. The mean age was 73 years (range, 63–79 years). All operations were performed laparoscopically. The median postoperative hospital stay was 3 days. After a mean follow-up of 18 months (range, 8-29 months), only 3 patients developed clinical recurrence of reflux symptoms (11%), and 2 had radiological recurrences (7%). No mesh-related complications occurred. Conclusions TiO2Mesh™ was found to be safe for laparoscopic repair of LPHH with a fairly low recurrence rate in this short-term study. Long-term studies conducted over a period of years with large sample sizes will be essential for confirming whether this mesh is suitable as a standard method of care with few drawbacks.
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Affiliation(s)
- Islam Khaled
- Department of Surgery, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Pablo Priego
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain.
| | - Mohammed Faisal
- Department of Surgery, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Marta Cuadrado
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Francisca García-Moreno
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Araceli Ballestero
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Julio Galindo
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Eduardo Lobo
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
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18
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Li J, Cheng T. Mesh erosion after hiatal hernia repair: the tip of the iceberg? Hernia 2019; 23:1243-1252. [DOI: 10.1007/s10029-019-02011-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
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Abstract
A hiatus hernia is defined as a transdiaphragmatic protrusion/migration of the intrabdominal contents through the esophageal hiatus of the diaphragm. The classification of hiatus hernias is based on anatomical morphological differentiation (types I-IV). The leading symptoms and psychological stress vary with respect to the symptoms, e. g. reflux and compression symptoms. Gastroscopy and multichannel intraluminal impedance pH measurement are obligatory preoperative functional diagnostics. A distinction is made between frequent type I hernia (antireflux surgery), symptomatic paraesophageal, thoracic and mixed hernia types (II-IV). Surgical indications exist in symptomatic type II-IV hernias. Hiatal mesh augmentation reduces recurrences. The complication potential of synthetic meshes must be taken into account. Biological implants show no advantages.
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20
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Shrestha AK, Joshi M, DeBono L, Naeem K, Basu S. Laparoscopic repair of type III/IV giant para-oesophageal herniae with biological prosthesis: a single centre experience. Hernia 2019; 23:387-396. [PMID: 30661178 DOI: 10.1007/s10029-019-01888-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/09/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Repair of giant paraoesophageal herniae (GPEH) is technically challenging and requires significant experience in advanced foregut surgery. Controversy continues on suture versus mesh cruroplasty with the most recent systematic review and meta-analysis putting the onus on the operating surgeon. Study aim was to review whether the biological prosthesis (non-cross-linked bovine pericardium and porcine dermis) and the technique adopted for patients with GPEH had an influence on clinical and radiological recurrences. METHOD A retrospective analysis of a prospectively collected data of 60 consecutive patients with confirmed 5 cm hiatus hernia and ≥ 30% stomach displacement in the thorax that were operated in the upper gastrointestinal unit of a large district general hospital between September 2010 and August 2017. Pre and post-surgery Gastro-Oesophageal Reflux Disease Questionnaire [(GORD-HRQOL)] and a follow up contrast study were completed. RESULTS 60 included 2 (3%) and 58 (97%) emergency and elective procedures respectively with a male: female ratio of 1:3, age 71* (Median) (42-89) years, BMI 29* (19-42) and 26 (43%) with ASA III/IV. Investigations confirmed 46* (37-88) mm and 42* (34-77) mm transverse and antero-posterior hiatal defect respectively with 60* (30-100)% displacement of stomach into chest. Operative time and length of stay was 180* (120-510) minutes and 2* (1-30) days respectively. One (2%) converted for bleeding and 2 (3%) peri-operative deaths. Five (8%), 5 (8%) and 4 (7%) have dysphagia, symptomatic and radiological recurrences respectively. GORD-HRQOL recorded preoperatively was 27* (10-39) dropping significantly postoperatively to 0* (0-21) (P < 0.005) with 95% patient satisfaction at a follow up of 60* (36-84) months. CONCLUSIONS Our technique of laparoscopic GPEH repair with biological prosthesis is safe with a reduced symptomatic and radiological recurrence and an acceptable morbidity and mortality.
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Affiliation(s)
- A K Shrestha
- Department of General Surgery, East Kent Hospitals University NHS Foundation Trust (EKHUFT), Ashford, Kent, UK
| | - M Joshi
- Department of General Surgery, East Kent Hospitals University NHS Foundation Trust (EKHUFT), Ashford, Kent, UK
| | - L DeBono
- Department of Surgery, One Ashford Hospital, Willesborough, Ashford, Kent, UK
| | - K Naeem
- Department of Radiology, EKHUFT, Ashford, Kent, UK
| | - S Basu
- Department of Surgery, EKHUFT, Ashford, Kent, UK. .,Department of Surgery, William Harvey Hospital, Ashford, Kent, TN24 0LZ, UK.
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21
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Oguri Y, Cho H, Yajima K, Oohinata R, Iwasaki Y. Case of complete mesh migration into the stomach after mesh hiatoplasty for a hiatal hernia. Asian J Endosc Surg 2018; 11:395-398. [PMID: 29361648 DOI: 10.1111/ases.12459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
Mesh migration is a rare complication of surgery for a hiatal hernia. Here, we present the case of a 72-year-old who complained of dysphasia and bodyweight loss. Upper gastrointestinal endoscopy revealed incarcerated mesh in the lumen of the esophagogastric junction. Surgery was performed under both endoscopy and laparoscopy, and the mesh was successfully removed via gastrostomy. To the best of our knowledge, our case is the first in which mesh that had migrated into the esophagogastric junction was removed by a combination of laparoscopic and endoscopic procedure, although the cases of 17 patients in which mesh migrated into the stomach after mesh hiatoplasty have previously been reported in the literature.
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Affiliation(s)
- Yohei Oguri
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Haruhiko Cho
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Kazuhito Yajima
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Ryouki Oohinata
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yoshiaki Iwasaki
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
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Abstract
Background and Objectives Laparoscopic paraesophageal hernia repair (LPEHR) is the new standard, but the use of mesh is still debated. Biologic mesh has shown great promise, but only the U-shaped onlay has been extensively studied. Postoperative dysphagia has historically been a concern with the use of synthetic keyhole mesh and subsequently slowed its adoption. The purpose of our study was to identify the incidence of postoperative dysphagia in a series of patients who underwent laparoscopic paraesophageal hernia repair with novel placement of keyhole biologic mesh. Methods Thirty consecutive patients who underwent hernia repair with primary suture cruroplasty and human acellular dermal matrix keyhole mesh reinforcement were reviewed over a 2-year period. All procedures were performed at a single institution. Postoperative symptoms were retrospectively identified. Any postoperative hernia on imaging was defined as radiographic recurrence. Results Of the 30 consecutive patients who underwent hernia repair, 3 (10%) had mild preoperative dysphagia. The number remained unchanged after LPEHR with keyhole mesh. Return of mild reflux symptoms occurred in 6 (20%) patients. Repeat imaging was performed in 11 patients (37%) at an average of 8 months with 2 slight recurrences. All hernias were classified on preoperative imaging as large hiatal hernias. There were no postoperative complications. Conclusion Laparoscopic paraesophageal hernia repair with biologic keyhole mesh reinforcement has a low recurrence rate and no increase in postoperative dysphagia. The traditional belief that keyhole mesh has a higher incidence of dysphagia was not evident in this series.
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Affiliation(s)
- Jeffrey R Watkins
- Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA
| | - Michael S Truitt
- Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA
| | - Houssam Osman
- Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA
| | - Rohan D Jeyarajah
- Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA
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23
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Olson MT, Singhal S, Panchanathan R, Roy SB, Kang P, Ipsen T, Mittal SK, Huang JL, Smith MA, Bremner RM. Primary paraesophageal hernia repair with Gore® Bio-A® tissue reinforcement: long-term outcomes and association of BMI and recurrence. Surg Endosc 2018; 32:4506-4516. [PMID: 29761272 DOI: 10.1007/s00464-018-6200-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic repair remains the gold-standard treatment for paraesophageal hernia (PEH). We analyzed long-term symptomatic outcomes and surgical reintervention rates after primary PEH repair with onlay synthetic bioabsorbable mesh (W. L. Gore & Associates, Inc., Flagstaff, AZ) and examined body mass index (BMI) as a possible risk factor for poor outcomes and for recurrence. METHODS We queried a prospectively maintained database to identify patients who underwent laparoscopic primary PEH repair with onlay patch of a bioprosthetic absorbable mesh (Bio-A® Gore®) between 05/28/2009 and 12/31/2013. Electronic health records were accessed to record demographic and operative data and were reviewed up to the present to identify any repeat procedures. Patients were grouped according to preoperative BMI (A: BMI < 25; B: BMI = 25-29.9; C: BMI = 30-34.9; D: BMI ≥ 35). Patients completed standardized satisfaction and symptom surveys. RESULTS In total, 399 patients were included. Most patients (n = 261; 65.4%) were women. Mean age was 59.6 ± 13.4 years; mean BMI was 29.9 ± 5.0 kg/m2. The patients were grouped as follows: A, 53 patients (13.3%); B, 166 (41.6%); C, 115 (28.8%); D: 65 (16.3%). Four procedures (1.0%) were converted from laparoscopy to open procedures. All patients underwent an antireflux procedure (225 Nissen, 170 Toupet, 4 Dor). A mean follow-up of 44.7 ± 22.8 months was available for 305 patients (76.4%). 24/305 patients (7.9%) underwent reoperation, and the number of reoperations did not differ among groups (P = 0.64). Long-term symptomatic outcomes were available for 217/305 patients (71.1%) at a mean follow-up of 54.0 ± 13.1 months; no significant difference was observed among groups. 194/217 patients (89.4%) reported good to excellent satisfaction, with no significant differences among the groups. CONCLUSIONS Laparoscopic primary PEH repair with onlay Bio-A® mesh is a safe and feasible procedure with excellent long-term patient-centered outcomes and acceptable symptomatic recurrence rate. BMI does not appear to be related to the need for surgical reintervention.
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Affiliation(s)
- Michael T Olson
- Grand Canyon University College of Science, Engineering, and Technology, Phoenix, AZ, USA.,Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Saurabh Singhal
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Roshan Panchanathan
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA.,University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Sreeja Biswas Roy
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Paul Kang
- University of Arizona College of Public Health, Phoenix, AZ, USA
| | - Taylor Ipsen
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA.,Midwestern University College of Osteopathic Medicine, Glendale, AZ, USA
| | - Sumeet K Mittal
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Jasmine L Huang
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Michael A Smith
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA.
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A perspective on the physical, mechanical and biological specifications of bioinks and the development of functional tissues in 3D bioprinting. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.bprint.2018.02.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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25
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Abstract
High rates of recurrence in hiatus hernia and antireflux surgery led to the introduction of different methods for diaphragm closure. Prosthetic diaphragm closure with meshes remains a controversial issue in the literature. Available data show lower recurrence rates after prosthetic diaphragm closure; however, there is no clear standard for the indications and technique. Despite the availability of a few prospective randomized trials, a clear recommendation regarding this issue cannot currently be given.
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26
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Castelijns PSS, Ponten JEH, Vd Poll MCG, Bouvy ND, Smulders JF. Quality of life after Nissen fundoplication in patients with gastroesophageal reflux disease: Comparison between long- and short-term follow-up. J Minim Access Surg 2018; 14:213-220. [PMID: 28928332 PMCID: PMC6001306 DOI: 10.4103/jmas.jmas_75_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Nissen fundoplication is the golden standard for surgical treatment of gastroesophageal reflux disease (GERD). Numerous studies report excellent short-term results. However, data regarding long-term quality of life are lacking. The aim of this study is to investigate the long-term quality of life after Nissen fundoplication in patients with GERD and to compare this with the short-term results. Patients and Methods: We retrospectively analysed all patients who underwent laparoscopic Nissen fundoplication for GERD between January 2004 and January 2016. All patients received a validated GERD-Health-Related Quality of Life questionnaire by mail to assess post-operative quality of life. Maximum quality of life is represented by a score of 75. Secondary outcome measures were complications and recurrence rate. Results: One hundred and seventy-five (77.1%) of the 227 operated patients returned the questionnaire. The median follow-up was 3.7 (0.1–10.3) years. Mean age was 51.6 (range 15–85) and 72 patients were male. We report an excellent quality of life with a median total score of 70 (range 2–75). Re-operation rate was 13.6% (23/169); the re-operation was due to recurrent reflux in 12 patients and due to persistent dysphagia in 11 patients. 91.3% of the re-operations were performed within the first 5 years after surgery. Mortality rate was zero. Conclusion: We report a large series of single-centre, single-surgeon laparoscopic Nissen fundoplication. Despite the re-operation rate of 13.6%, we found excellent long-term symptomatic outcome. There was no difference between short- and long-term results.
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Affiliation(s)
- P S S Castelijns
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - J E H Ponten
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - M C G Vd Poll
- Department of Surgery, MUMC+; Department of Intensive Care, 6229 HX Maastricht, The Netherlands
| | - N D Bouvy
- Department of Surgery, MUMC+, 6229 HX Maastricht, The Netherlands
| | - J F Smulders
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
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27
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Castelijns PSS, Ponten JEH, van de Poll MCG, Nienhuijs SW, Smulders JF. A collective review of biological versus synthetic mesh-reinforced cruroplasty during laparoscopic Nissen fundoplication. J Minim Access Surg 2017; 14:87-94. [PMID: 28928334 PMCID: PMC5869985 DOI: 10.4103/jmas.jmas_91_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Laparoscopic cruroplasty and fundoplication have become the gold standard in the treatment of hiatal hernia and gastro-oesophageal reflux disease (GERD). The use of a mesh-reinforcement of the cruroplasty has been proven effective; although, there is a lack of evidence considering which type of mesh is superior. The aim of this study was to compare recurrence rates after mesh reinforced cruroplasty using biological versus synthetic meshes. Methods: We performed a systematic review of all clinical trials published between January 2004 and September 2015 describing the application of a mesh in the hiatal hernia repair during Nissen fundoplication for both GERD and hiatal hernia. The primary outcome was the recurrence rate, and secondary outcomes were complication rate, mortality and symptomatic outcome. Results: We included 16 studies and extracted data regarding 1089 mesh operated patients of whom 385 received a biological mesh and 704 a synthetic mesh. The mean follow-up was 53.4 months. The recurrence rate in the synthetic mesh group was 6.8% compared to 16.1% in the biological mesh group (P < 0.05). The complication rate was 5.1% and 4.6% (P = 0.694), respectively, and there were 12 mesh-related complications. No mesh-related mortality was reported. Conclusion: Mesh reinforcement of hiatal hernia repair seems safe in the short-term follow-up. The available literature suggests no clear advantage of biological over synthetic meshes. Regarding cost-efficiency and short-term results, the use of synthetic nonabsorbable meshes might be advocated.
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Affiliation(s)
- P S S Castelijns
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - J E H Ponten
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - M C G van de Poll
- Department of Surgery and Intensive Care Medicine, MUMC+, 6229 HX Maastricht, The Netherlands
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - J F Smulders
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
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28
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Abu Saleh WK, Morris LM, Tariq N, Kim MP, Chan EY, Meisenbach LM, Dunkin BJ, Sherman V, Rosenberg W, Bass BL, Graviss EA, Nguyen DT, Reardon P, Khaitan PG. Routine use of mesh during hiatal closure is safe with no increase in adverse sequelae. Surg Endosc 2017; 32:879-888. [PMID: 28917000 DOI: 10.1007/s00464-017-5758-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/14/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Primary laparoscopic hiatal repair with fundoplication is associated with a high recurrence rate. We wanted to evaluate the potential risks posed by routine use of onlay-mesh during hiatal closure, when compared to primary repair. METHODS Utilizing single-institutional database, we identified patients who underwent primary laparoscopic hiatal repair from January 2005 through December 2014. Retrospective chart review was performed to determine perioperative morbidity and mortality. Long-term results were assessed by sending out a questionnaire. Results were tabulated and patients were divided into 2 groups: fundoplication with hiatal closure + absorbable or non-absorbable mesh and fundoplication with hiatal closure alone. RESULTS A total of 505 patients underwent primary laparoscopic fundoplication. Mesh reinforcement was used in 270 patients (53.5%). There was no significant difference in the 30-day perioperative outcomes between the 2 groups. No clinically apparent erosions were noted and no mesh required removal. Standard questionnaire was sent to 475 patients; 174 (36.6%) patients responded with a median follow-up of 4.29 years. Once again, no difference was noted between the 2 groups in terms of dysphagia, heartburn, long-term antacid use, or patient satisfaction. Of these, 15 patients (16.9%, 15/89) in the 'Mesh' cohort had symptomatic recurrence as compared to 19 patients (22.4%, 19/85) in the 'No Mesh' cohort (p = 0.362). A reoperation was necessary in 6 patients (6.7%) in the 'Mesh' cohort as compared to 3 patients (3.5%) in the 'No Mesh' cohort (p = 0.543). CONCLUSIONS Onlay-mesh use in laparoscopic hiatal repair with fundoplication is safe and has similar short and long-term results as primary repair.
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Affiliation(s)
- Walid K Abu Saleh
- Department of General Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Lee M Morris
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Nabil Tariq
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Min P Kim
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
- Division of Thoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Edward Y Chan
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
- Division of Thoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Leonora M Meisenbach
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
- Division of Thoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Brian J Dunkin
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Vadim Sherman
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Wade Rosenberg
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Barbara L Bass
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Patrick Reardon
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Puja G Khaitan
- Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA.
- Division of Thoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA.
- Department of Surgery, Division of Thoracic Surgery, Houston Methodist Hospital, 6550 Fannin St., Smith Tower, Suite 1601, Houston, 77030, TX, USA.
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Spann MD, Aher CV, English WJ, Williams DB. Endoscopic management of erosion after banded bariatric procedures. Surg Obes Relat Dis 2017; 13:1875-1879. [PMID: 28870760 DOI: 10.1016/j.soard.2017.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/29/2017] [Accepted: 07/17/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prosthetic materials wrapped around a portion of the stomach have been used to provide gastric restriction in bariatric surgery for many years. Intraluminal erosion of adjustable and nonadjustable gastric bands typically occurs many years after placement and results in various symptoms. Endoscopic management of gastric band erosion has been described and allows for optimal patient outcomes. OBJECTIVES We will describe our methods and experience with endoscopic management of intraluminal gastric band erosions after bariatric procedures. SETTING University hospital in the United States. METHODS A retrospective review of our bariatric surgery database identified patients undergoing removal of gastric bands. A chart review was then undertaken to confirm erosion of prosthetic material into the gastrointestinal tract. Baseline characteristics, operative reports, and follow-up data were analyzed. RESULTS Sixteen patients were identified with an eroded gastric band: 11 after banded gastric bypass, 3 after laparoscopic adjustable gastric band (LAGB), and 2 after vertical banded gastroplasty. All patients were successfully treated with endoscopic removal of the prosthetic materials using either endoscopic scissors or ligation of the banding material with off-label use of a mechanical lithotripter device. Complications included a postoperative gastrointestinal bleed requiring repeat endoscopy, 1 patient with asymptomatic pneumoperitoneum requiring observation, and 1 with seroma at the site of LAGB port removal. CONCLUSIONS Endoscopic management of intraluminal prosthetic erosion after gastric banded bariatric procedures can be safe and effective and should be considered when treating this complication. Erosion of the prosthetic materials inside the gastric lumen allows for potential endoscopic removal without free intraabdominal perforation. Endoscopic devices designed for dividing eroded LAGBs may help standardize and increase utilization of this approach.
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Affiliation(s)
- Matthew D Spann
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Chetan V Aher
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wayne J English
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee
| | - D Brandon Williams
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee
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Jung JJ, Naimark DM, Behman R, Grantcharov TP. Approach to asymptomatic paraesophageal hernia: watchful waiting or elective laparoscopic hernia repair? Surg Endosc 2017; 32:864-871. [DOI: 10.1007/s00464-017-5755-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/14/2017] [Indexed: 12/31/2022]
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Prusa AM, Kristo I, Rieder E, Ringhofer C, Asari R, Miholic J, Schoppmann SF. Tension-Free Inlay Repair of Large Hiatal Hernias Using Dual-Sided Composite PTFE/ePTFE Meshes in Laparoscopic Surgery for Gastroesophageal Reflux Disease. J Laparoendosc Adv Surg Tech A 2017; 27:710-714. [PMID: 28445106 DOI: 10.1089/lap.2016.0371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with gastroesophageal reflux disease (GERD) also frequently suffer from concomitant hiatal hernia. It has been described that a preoperative hiatal hernia of ≥3 cm is associated with a more than threefold relative risk for reflux symptom recurrence after fundoplication without mesh reinforcement. In this report, we describe our experience with the implantation of dual-sided composite PTFE/ePTFE meshes in a tension-free fashion during laparoscopic antireflux surgery (LARS). METHODS A prospective database containing data of all patients undergoing LARS and hiatal hernia repair with mesh implantation from January 2009 until December 2014 was interrogated. Ten patients with preoperative esophageal high resolution manometry and 24-hour pH impedance monitoring because of symptoms suggestive of GERD who received hiatal repair using dual-sided meshes in inlay technique were identified and included in this analysis. RESULTS There were no conversions to open surgery in the study group. Median operative time was 138 minutes (interquartile range Q1-Q3: 119-151 minutes) and average length of postoperative stay was 3.5 days (interquartile range Q1-Q3: 2.3-4.0 days). During a median follow-up period of 43.3 months (interquartile range Q1-Q3: 18.9-47.1 months), no redo operations had to be performed. Noteworthy, 2 patients complained about dysphagia (20%) during follow-up, but symptoms resolved after endoscopic interventions. CONCLUSIONS Tension-free inlay repair of large hiatal hernias using dual-sided composite PTFE/ePTFE meshes during LARS provides promising results. It provides satisfactory symptom relief and prolonged control of GERD. Further studies to validate its efficiency in a larger collective are needed.
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Affiliation(s)
- Alexander M Prusa
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria
| | - Ivan Kristo
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria .,2 Manometry Laboratory, Department of Surgery, Medical University of Vienna , Vienna, Austria
| | - Erwin Rieder
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria
| | - Claudia Ringhofer
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria .,2 Manometry Laboratory, Department of Surgery, Medical University of Vienna , Vienna, Austria
| | - Reza Asari
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria
| | - Johannes Miholic
- 3 Department of Surgery, Medical University of Vienna , Vienna, Austria
| | - Sebastian F Schoppmann
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria .,2 Manometry Laboratory, Department of Surgery, Medical University of Vienna , Vienna, Austria
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Abstract
Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of gastroesophageal reflux in surgical clinics. Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients. The objective of this study is to evaluate the mechanism of recurrences after antireflux surgery and to share our results after revision surgery in recurrent cases.From 2001 to 2014, revision surgery was performed on 43 patients (31 men, 12 women) between the ages of 24 and 70 years. The technical details of the first operation, recurrence symptoms, endoscopy, and manometry findings were evaluated. The findings of revision surgery, surgical techniques, morbidity rates, length of hospitalization, and follow-up period were also recorded and evaluated.The first operation was Nissen fundoplication in 34 patients and Toupet fundoplication in 9 patients. Mesh hiatoplasty was performed for enforcement in 18 (41.9%) of these patients. The period between the first operation and the revision surgery ranged from 4 days to 60 months. The most common finding was slipped fundoplication and presence of hiatal hernia during revision surgery. Revision fundoplication and hernia repair with mesh reinforcement were used in 33 patients. The other techniques were Collis gastroplasty, revision fundoplication, and hernia repair without mesh. The range of follow-up period was from 2 to 134 months. Recurrence occurred in 3 patients after revision surgery (6.9%). Although revision surgery is difficult and it has higher morbidity, it can be performed effectively and safely in experienced centers.
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Affiliation(s)
| | - Volkan Genc
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Suleyman Utku Celik
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
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Iannelli A, Sans A, Martini F, Santonicola A, Iovino P, Angrisani L. Hiatal Hernia, GERD, and Sleeve Gastrectomy: a Complex Interplay. Obes Surg 2016; 26:2485-2487. [PMID: 27460694 DOI: 10.1007/s11695-016-2291-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Antonio Iannelli
- Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestière, BP 3079, Nice Cedex 3, France.
- Inserm, U1065, Team 8 "Hepatic complications of obesity", F-06204, Nice, France.
- University of Nice Sophia-Antipolis, F-06107, Nice, France.
| | - Arnaud Sans
- Inserm, U1065, Team 8 "Hepatic complications of obesity", F-06204, Nice, France
| | | | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Luigi Angrisani
- General and Endoscopic Surgery Unit, S. Giovanni Bosco Hospital, Naples, Italy
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Priego P, Perez de Oteyza J, Galindo J, Carda P, García-Moreno F, Rodríguez Velasco G, Lobo E. Long-term results and complications related to Crurasoft ® mesh repair for paraesophageal hiatal hernias. Hernia 2016; 21:291-298. [PMID: 27023877 DOI: 10.1007/s10029-016-1486-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 03/19/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates in comparison with primary suture repair. However, the use of meshes has not completely extended in all the cases of large paraesophageal hiatal hernias (LPHH) due to the complications related to them. The aim of this study is to present our long-term results and complications related to Crurasoft® mesh (Bard) for the treatment of LPHH. METHODS From January 2004 to December 2014, 536 consecutive patients underwent open or laparoscopic fundoplication for gastroesophageal reflux disease or LPHH at Ramón y Cajal University Hospital. Primary simple suture of the crura and additional reinforcement with a Crurasoft® mesh (Bard) was performed in 93 patients (17.35 %). Radiologic hiatal hernia recurrence and mesh-related complications were investigated. RESULTS Of the 93 patients undergoing mesh repair, there were 28 male and 65 female with a mean age of 67.27 years (range 22-87 years). Laparoscopic surgery was attended in 88.2 % of the cases, and open surgery in the rest 11.8 %. Mean operative time was 167.05 min (range 90-370 min). Median postoperative stay was 4.79 days (range 1-41 days). Conversion rate was 8.53 % (7 patients). Intraoperative complications were described in 10.75 % (10 patients), but all of them, except in one case, could be managed laparoscopically. Overall postoperative complications rate was 28 %. Early postoperative complications occurred in 11 patients (12 %), respectively, for grades 2 (6 cases), 3b (1 case) and 5 (4 cases) according to the Clavien-Dindo classification. Late postoperative complications occurred in 15 patients (16 %), respectively, for grades 1 (7 cases), 2 (2 cases), 3b (5 cases) and 5 (1 case) according to the Clavien-Dindo classification. Thirty day-mortality rate was 4.3 %. Mortality rate specific associated with the mesh was 1 %. Reoperation rate was 5.4 %. After a median follow-up of 76.33 months (range 3-130 months), 8 patients (9 %) developed a recurrent hiatal hernia. Mesh was removed in three cases (3.22 %). CONCLUSIONS In our experience, the recurrence rate in patients with a Crurasoft® (Bard) is acceptable. However, the rate of postoperative complications and mortality is excessive. The use of meshes in the hiatus keeps on being controversial due to the severe complications related to them. It would be advisable to compare our results in the non-mesh group in terms of recurrences and complications, to determine if meshes in the hiatus should be given in these patients due to its high rate of complications.
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Affiliation(s)
- P Priego
- Division of Upper&GI, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain. .,, C/Fermín Caballero 26, 1ºA, 16004, Cuenca, Spain.
| | - J Perez de Oteyza
- Division of Upper&GI, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - J Galindo
- Division of Upper&GI, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - P Carda
- Division of Upper&GI, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - F García-Moreno
- Division of Upper&GI, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - G Rodríguez Velasco
- Division of Upper&GI, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - E Lobo
- Division of Upper&GI, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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Antonakis F, Köckerling F, Kallinowski F. Functional Results after Repair of Large Hiatal Hernia by Use of a Biologic Mesh. Front Surg 2016; 3:16. [PMID: 27014698 PMCID: PMC4783575 DOI: 10.3389/fsurg.2016.00016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/25/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this observational study is to analyze the results of patients with large hiatal hernia and upside-down stomach after surgical closure with a biological mesh (Permacol(®), Covidien, Neustadt an der Donau, Germany). Biological mesh is used to prevent long-term detrimental effects of artificial meshes and to reduce recurrence rates. METHODS A total of 13 patients with a large hiatal hernia and endothoracic stomach, who underwent surgery between 2010 and 2014, were included. Interviews and upper endoscopy were conducted to determine recurrences, lifestyle restrictions, and current complaints. RESULTS After a mean follow-up of 26 ± 18 months (range: 3-58 months), 10 patients (3 men, mean age 73 ± 13, range: 26-81 years) were evaluated. A small recurrent axial hernia was found in one patient postoperatively. Dysphagia was the most common complaint (four cases); while in one case, the problem was solved after endoscopic dilatation. In three cases, bloat and postprandial pain were documented. In one case, an explantation of the mesh was necessary due to mesh migration and painful adhesions. In one further case with gastroparesis, pyloroplasty was performed without success. The data are compared to the available literature. It was found that dysphagia and recurrence rates are unrelated both in biological and in synthetic meshes if the esophagus is encircled. In series preserving the esophagus at least partially uncoated, recurrences after the use of biological meshes relieve dysphagia. After the application of synthetic meshes, dysphagia is aggravated by recurrences. CONCLUSION Recurrence is rare after encircling hiatal hernia repair with the biological mesh Permacol(®). Dysphagia, gas bloat, and intra-abdominal pain are frequent complaints. Despite the small number of patients, it can be concluded that a biological mesh may be an alternative to synthetic meshes to reduce recurrences at least for up to 2 years. Our study demonstrates that local fibrosis and thickening of the mesh can affect the outcome being associated with abdominal discomfort despite a successful repair. The review of the literature indicates comparable results after 2 years with both biologic and synthetic meshes embracing the esophagus. At the same point in time, reconstruction with synthetic and biologic materials differs when the esophagus is not or only partially encircled in the repair. This is important since encircling artificial meshes can erode the esophagus after 5-10 years.
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Affiliation(s)
- Filimon Antonakis
- Department of General and Visceral Surgery, Asklepios Klinikum Harburg , Hamburg , Germany
| | - Ferdinand Köckerling
- Department of General, Visceral and Vascular Surgery, Vivantes Klinikum Spandau , Berlin , Germany
| | - Friedrich Kallinowski
- Department of General and Visceral Surgery, Asklepios Klinikum Harburg , Hamburg , Germany
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Prolene Suture Web-Shoelace–Like Pattern: An Alternative to Avoid the Use of Mesh in the Repair of a Large Hiatus Hernia. J Laparoendosc Adv Surg Tech A 2015; 25:1019-24. [DOI: 10.1089/lap.2015.0279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence. Surg Endosc 2015; 30:2374-81. [DOI: 10.1007/s00464-015-4487-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/01/2015] [Indexed: 12/11/2022]
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Tam V, Winger DG, Nason KS. A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair. Am J Surg 2015; 211:226-38. [PMID: 26520872 DOI: 10.1016/j.amjsurg.2015.07.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/22/2015] [Accepted: 07/17/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Equipoise exists regarding whether mesh cruroplasty during laparoscopic large hiatal hernia repair improves symptomatic outcomes compared with suture repair. DATA SOURCE Systematic literature review (MEDLINE and EMBASE) identified 13 studies (1,194 patients; 521 suture and 673 mesh) comparing mesh versus suture cruroplasty during laparoscopic repair of large hiatal hernia. We abstracted data regarding symptom assessment, objective recurrence, and reoperation and performed meta-analysis. CONCLUSIONS The majority of studies reported significant symptom improvement. Data were insufficient to evaluate symptomatic versus asymptomatic recurrence. Time to evaluation was skewed toward longer follow-up after suture cruroplasty. Odds of recurrence (odds ratio .51, 95% confidence interval .30 to .87; overall P = .014) but not need for reoperation (odds ratio .42, 95% confidence interval .13 to 1.37; overall P = .149) were less after mesh cruroplasty. Quality of evidence supporting routine use of mesh cruroplasty is low. Mesh should be used at surgeon discretion until additional studies evaluating symptomatic outcomes, quality of life, and long-term recurrence are available.
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Affiliation(s)
- Vernissia Tam
- Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA, USA
| | - Daniel G Winger
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katie S Nason
- Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA, USA.
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Kang T, Urrego H, Gridley A, Richardson WS. Pledgeted repair of giant hiatal hernia provides excellent long-term results. J Laparoendosc Adv Surg Tech A 2014; 24:684-687. [PMID: 25181468 DOI: 10.1089/lap.2013.0447] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Use of mesh in hiatal hernia repairs is a topic of debate. We present our experience in laparoscopic primary (nonmesh) repair of giant hiatal hernia. MATERIALS AND METHODS All laparoscopic antireflux procedures done by a single surgeon from November 1997 to October 2006 were retrospectively reviewed. Inclusion criteria were primary crural closure with pledgets and giant hiatal hernia (greater than one-third of the stomach in the chest by esophagram, greater than 5 cm in length endoscopically, or greater than one-third of the stomach in the chest operatively). We attempted to reach all patients who met inclusion criteria and administered the Reflux Symptom Index (RSI) and Quality of Life Scale for Gastroesophageal Reflux Disease (QLSGR) questionnaires. RESULTS In total, 89 patients met inclusion criteria. The male-to-female ratio was 32:57. Average age was 62.7 years. Average body mass index was 29.3 kg/m(2). Average length of stay was 2 days, and mean clinic follow-up was 161 days. At the most recent follow-up, 62% of patients were asymptomatic. The most common postoperative symptoms were dysphagia (16%), reflux/emesis (5%), bloating (5%), nausea (4%), epigastric pain (4%), and heartburn (3%). There were six (6.7%) recurrences on esophagogastroduodenoscopy or upper gastrointestinal examination. Five patients with recurrence were symptomatic. Of the 89 patients, 29 (33%) completed the questionnaire, with a mean follow-up of 69.7 months. Average RSI score was 12 (maximum possible score, 45). In six of nine categories, the average score was less than 1 (possible score, 0-5). Average QLSGR score was 12 (maximum possible score, 45). For satisfaction with the present condition, the average score was 4.34 (maximum score, 5), and 82.7% of respondents were satisfied or very satisfied with their present condition. CONCLUSIONS Laparoscopic primary repair of giant hiatal hernia provides excellent long-term results. We found that 62% of patients were asymptomatic at the last follow-up and that 82% of respondents were satisfied or very satisfied. The recurrence rate was 6.7%.
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Affiliation(s)
- Thomas Kang
- 1 Department of General Surgery, Ochsner Clinic , New Orleans, Louisiana
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Priego Jiménez P, Salvador Sanchís JL, Angel V, Escrig-Sos J. Short-term results for laparoscopic repair of large paraesophageal hiatal hernias with Gore Bio A® mesh. Int J Surg 2014; 12:794-7. [PMID: 24947948 DOI: 10.1016/j.ijsu.2014.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/24/2014] [Accepted: 06/02/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates in comparison with primary suture repair. One of the most debated issues is the risk of complications related to the use of the prosthesis, such as esophageal erosion and postoperative dysphagia. The aim of this study is to present our short-terms results in the treatment of laparoscopic paraesophageal hiatal hernia (LPHH) with a synthetic polyglycolic acid:trimethylene carbonate mesh (Gore Bio A(®)). METHODS From January 2011 to December 2012, 10 patients with large paraesophageal hiatal hernias and hiatal defect over 5 cm were included. Primary simple suture of the crura and additional reinforcement with a Gore Bio A(®) mesh was performed. Hiatal hernia or gastroesophageal reflux disease (GERD) symptoms recurrence, dysphagia and mesh-related complications were investigated. RESULTS Of the 10 patients undergoing mesh repair, there were 7 women and 3 men with a mean age of 65.5 years. All operations were completed laparoscopically. Median postoperative stay was 3 days. After a median follow-up of 20.3 months, one patient developed a recurrent hiatal hernia (10%). There were no mesh-related complications. CONCLUSIONS The use of Gore Bio A(®) mesh for the laparoscopic repair of large paraesophageal hiatal hernias is safe and with a reasonably low recurrence rate in this short-term study. Additional long-term studies with ample numbers carried out for years will be necessary to see if this synthetic mesh is not only safe but also successful in the prevention of recurrences.
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Affiliation(s)
- Pablo Priego Jiménez
- Department of General Surgery, Upper Gastrointestinal Unit, Hospital General Castellón, Avda. Benicassim s/n, 12004 Castellón, Spain.
| | - José Luis Salvador Sanchís
- Department of General Surgery, Upper Gastrointestinal Unit, Hospital General Castellón, Avda. Benicassim s/n, 12004 Castellón, Spain
| | - Vicente Angel
- Department of General Surgery, Upper Gastrointestinal Unit, Hospital General Castellón, Avda. Benicassim s/n, 12004 Castellón, Spain
| | - Javier Escrig-Sos
- Department of General Surgery, Upper Gastrointestinal Unit, Hospital General Castellón, Avda. Benicassim s/n, 12004 Castellón, Spain
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Qu H, Liu Y, He QS. Short- and long-term results of laparoscopic versus open anti-reflux surgery: a systematic review and meta-analysis of randomized controlled trials. J Gastrointest Surg 2014; 18:1077-86. [PMID: 24627259 DOI: 10.1007/s11605-014-2492-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 02/27/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is an ongoing debate about whether laparoscopic anti-reflux surgery (LARS) or open anti-reflux surgery (OARS) is the better option for the surgical treatment of gastroesophageal reflux disease (GERD). This study was aimed to evaluate and compare the short- and long-term results of both surgical strategies by means of a systematic review and meta-analysis. METHODS A systematic search of electronic databases (PubMed, Embase, The Cochrane Library) for studies published from 1970 to 2013 was performed. All randomized controlled trials (RCTs) that compared LARS with OARS were included. We analyzed the outcomes of each type of surgery over short- and long-term periods. RESULTS Twelve studies met final inclusion criteria (total n = 1,067). A total of 510 patients underwent OARS and 557 had LARS. The pooled analyses showed, despite of longer operation time, the hospital stay and sick leave were significantly reduced in the LARS group. Significant reductions were also observed in complication rates for the LARS group in both short (odds ratio (OR) 0.31, 95 % CI 0.17 to 0.56) and long-term periods (OR 0.24, 95 % CI 0.07 to 0.80). Although complaints of reflux symptoms were more frequent among LARS patients in the short-term follow-up, LARS achieved better control of reflux symptoms in the long-term period (P < 0.05). Reoperation rate, patient's satisfaction, and 24-h pH monitoring were all comparable between the two groups (all P > 0.05). CONCLUSIONS LARS is an effective and safe alternative of OARS for the surgical treatment of GERD, which enables a faster convalescence, better control of long-term reflux symptoms, and with reduced risk of complications.
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Affiliation(s)
- Hui Qu
- Department of General Surgery, Shandong University Qilu Hospital, No.107 of the west cultural road, Jinan, 250012, Shandong, China
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EAES recommendations for the management of gastroesophageal reflux disease. Surg Endosc 2014; 28:1753-73. [PMID: 24789125 DOI: 10.1007/s00464-014-3431-z] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 01/08/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is one of the most frequent benign disorders of the upper gastrointestinal tract. Management of GERD has always been controversial since modern medical therapy is very effective, but laparoscopic fundoplication is one of the few procedures that were quickly adapted to the minimal access technique. The purpose of this project was to analyze the current knowledge on GERD in regard to its pathophysiology, diagnostic assessment, medical therapy, and surgical therapy, and special circumstances such as GERD in children, Barrett's esophagus, and enteroesophageal and duodenogastroesophageal reflux. METHODS The European Association of Endoscopic Surgery (EAES) has tasked a group of experts, based on their clinical and scientific expertise in the field of GERD, to establish current guidelines in a consensus development conference. The expert panel was constituted in May 2012 and met in September 2012 and January 2013, followed by a Delphi process. Critical appraisal of the literature was accomplished. All articles were reviewed and classified according to the hierarchy of level of evidence and summarized in statements and recommendations, which were presented to the scientific community during the EAES yearly conference in a plenary session in Vienna 2013. A second Delphi process followed discussion in the plenary session. RESULTS Recommendations for pathophysiologic and epidemiologic considerations, symptom evaluation, diagnostic workup, medical therapy, and surgical therapy are presented. Diagnostic evaluation and adequate selection of patients are the most important features for success of the current management of GERD. Laparoscopic fundoplication is the most important therapeutic technique for the success of surgical therapy of GERD. CONCLUSIONS Since the background of GERD is multifactorial, the management of this disease requires a complex approach in diagnostic workup as well as for medical and surgical treatment. Laparoscopic fundoplication in well-selected patients is a successful therapeutic option.
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Silecchia G, Iossa A, Cavallaro G, Rizzello M, Longo F. Reinforcement of hiatal defect repair with absorbable mesh fixed with non-permanent devices. MINIM INVASIV THER 2014; 23:302-8. [PMID: 24773371 DOI: 10.3109/13645706.2014.909853] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM To report the results of an open label prospective study on a new technique for laparoscopic hiatal hernia (HH) repair with absorbable mesh fixed with absorbable materials Methods: From January 2011 to May 2013, 43 patients were treated; group A, 20 patients submitted to laparoscopic sleeve gastrectomy (LSG); group B, 13 patients submitted to revisional surgery for the diagnosis of HH and symptomatic GERD post-LSG; and group C, ten patients submitted to 360° fundoplication. All patients underwent cruroplasty reinforced with bio-absorbable mesh fixed with absorbable tacks and/or fibrin glue. Conversion rate, intra-operative complications, operative time (tacks vs tacks plus fibrin glue), perioperative complications, perioperative symptoms and radiological control set the criteria for clinical/surgical evaluation. RESULTS Conversion and mortality rate was 0%. The mean time for mesh fixation with the tacks vs tacks plus fibrin glue was 6.2 ± 2 vs 7.3 ± 3 min. The remission of GERD symptoms was observed in 39 patients, and we did not observe any cases of mesh-related complications at a mean follow-up of 17.4 months. Recurrence rate was 2.3% (one asymptomatic patient of group B). CONCLUSIONS Reinforcement with absorbable mesh-cancel bio mesh is a safe and effective option for laparoscopic HH repair in normal weight and obese patients.
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Affiliation(s)
- Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery & Bariatric Center of Excellence, University of Rome , Latina , Italy
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Bonavina L, Siboni S, Saino GI, Cavadas D, Braghetto I, Csendes A, Korn O, Figueredo EJ, Swanstrom LL, Wassenaar E. Outcomes of esophageal surgery, especially of the lower esophageal sphincter. Ann N Y Acad Sci 2013; 1300:29-42. [PMID: 24117632 DOI: 10.1111/nyas.12232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper includes commentaries on outcomes of esophageal surgery, including the mechanisms by which fundoduplication improves lower esophageal sphincter (LES) pressure; the efficacy of the Linx™ management system in improving LES function; the utility of radiologic characterization of antireflux valves following surgery; the correlation between endoscopic findings and reported symptoms following antireflux surgery; the links between laparoscopic sleeve gastrectomy and decreased LES pressure, endoscopic esophagitis, and gastroesophageal reflux disease (GERD); the less favorable outcomes following fundoduplication among obese patients; the application of bioprosthetic meshes to reinforce hiatal repair and decrease the incidence of paraesophageal hernia; the efficacy of endoluminal antireflux procedures, and the limited efficacy of revisional antireflux operations, underscoring the importance of good primary surgery and diligent work-up to prevent the necessity of revisional procedures.
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Affiliation(s)
- Luigi Bonavina
- General Surgery, IRCCS, University of Milano, Milano, Italy
| | - Stefano Siboni
- General Surgery, IRCCS, University of Milano, Milano, Italy
| | - Greta I Saino
- General Surgery, IRCCS, University of Milano, Milano, Italy
| | - Demetrio Cavadas
- Department of Surgery, Hospital Italiano, Buenos Aires, Argentina
| | - Italo Braghetto
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Attila Csendes
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Owen Korn
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Edgar J Figueredo
- Department of Surgery, University of Washington, Seattle, Washington
| | | | - Eelco Wassenaar
- Department of Surgery, University of Washington, Seattle, Washington
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Toydemir T, Çipe G, Karatepe O, Yerdel MA. Laparoscopic management of totally intra-thoracic stomach with chronic volvulus. World J Gastroenterol 2013; 19:5848-5854. [PMID: 24124329 PMCID: PMC3793138 DOI: 10.3748/wjg.v19.i35.5848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the outcomes of patients who underwent laparoscopic repair of intra-thoracic gastric volvulus (IGV) and to assess the preoperative work-up.
METHODS: A retrospective review of a prospectively collected database of patient medical records identified 14 patients who underwent a laparoscopic repair of IGV. The procedure included reduction of the stomach into the abdomen, total sac excision, reinforced hiatoplasty with mesh and construction of a partial fundoplication. All perioperative data, operative details and complications were recorded. All patients had at least 6 mo of follow-up.
RESULTS: There were 4 male and 10 female patients. The mean age and the mean body mass index were 66 years and 28.7 kg/m2, respectively. All patients presented with epigastric discomfort and early satiety. There was no mortality, and none of the cases were converted to an open procedure. The mean operative time was 235 min, and the mean length of hospitalization was 2 d. There were no intraoperative complications. Four minor complications occurred in 3 patients including pleural effusion, subcutaneous emphysema, dysphagia and delayed gastric emptying. All minor complications resolved spontaneously without any intervention. During the mean follow-up of 29 mo, one patient had a radiological wrap herniation without volvulus. She remains symptom free with daily medication.
CONCLUSION: The laparoscopic management of IGV is a safe but technically demanding procedure. The best outcomes can be achieved in centers with extensive experience in minimally invasive esophageal surgery.
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Zhang W, Tang W, Shan CX, Liu S, Jiang ZG, Jiang DZ, Zheng XM, Qiu M. Dual-sided composite mesh repair of hiatal hernia: Our experience and a review of the Chinese literature. World J Gastroenterol 2013; 19:5528-5533. [PMID: 24023497 PMCID: PMC3761107 DOI: 10.3748/wjg.v19.i33.5528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/06/2013] [Accepted: 07/05/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To summarize our experience in the application of Crurasoft® for antireflux surgery and hiatal hernia (HH) repair and to introduce the work of Chinese doctors on this topic.
METHODS: Twenty-one patients underwent HH repair with Crurasoft® reinforcement. Gastroesophageal reflux disease (GERD) and HH-related symptoms including heartburn, regurgitation, chest pain, dysphagia, and abdominal pain were evaluated preoperatively and 6 mo postoperatively. A patient survey was conducted by phone by one of the authors. Patients were asked about “recurrent reflux or heartburn” and “dysphagia”. An internet-based Chinese literature search in this field was also performed. Data extracted from each study included: number of patients treated, hernia size, hiatorrhaphy, antireflux surgery, follow-up period, recurrence rate, and complications (especially dysphagia).
RESULTS: There were 8 type I, 10 type II and 3 type III HHs in this group. Mean operative time was 119.29 min (range 80-175 min). Intraoperatively, length and width of the hiatal orifice were measured, (4.33 ± 0.84 and 2.85 ± 0.85 cm, respectively). Thirteen and eight Nissen and Toupet fundoplications were performed, respectively. The intraoperative complication rate was 9.52%. Despite dysphagia, GERD-related symptoms improved significantly compared with those before surgery. The recurrence rate was 0% during the 6-mo follow-up period, and long-term follow-up disclosed a recurrence rate of 4.76% with a mean period of 16.28 mo. Eight patients developed new-onset dysphagia. The Chinese literature review identified 12 papers with 213 patients. The overall recurrence rate was 1.88%. There was no esophageal erosion and the rate of dysphagia ranged from 0% to 24%.
CONCLUSION: The use of Crurasoft® mesh for HH repair results in satisfactory symptom control with a low recurrence rate. Postoperative dysphagia continues to be an issue, and requires more research to reduce its incidence.
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Defining recurrence after paraesophageal hernia repair: Correlating symptoms and radiographic findings. Surgery 2013; 154:171-8. [DOI: 10.1016/j.surg.2013.03.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/28/2013] [Indexed: 02/03/2023]
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Daes J, Jimenez ME, Said N, Daza JC, Dennis R. Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique. Obes Surg 2013; 22:1874-9. [PMID: 22915063 PMCID: PMC3505545 DOI: 10.1007/s11695-012-0746-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Bariatric surgery is the most effective treatment for gastro-esophageal reflux disease (GERD) in obese patients, with the Roux-en-Y gastric bypass being the technique preferred by many surgeons. Published data reporting the results of laparoscopic sleeve gastrectomy (LSG) in patients with GERD are contradictory. In a previous observational study, we found that relative narrowing of the distal sleeve, hiatal hernia (HH), and dilation of the fundus predispose to GERD after LSG. In this study, we evaluated the effects of standardization of our LSG technique on the incidence of postoperative symptoms of GERD. Methods This was a concurrent cohort study. Patients who underwent bariatric surgery at our center were followed prospectively. LSG was performed in all patients in this series. Results A total of 234 patients underwent surgery. There were no cases of death, fistula, or conversion to open surgery. All 134 patients who completed 6–12 months of postoperative follow-up were evaluated. Excess weight loss at 1 year was 73.5 %. In the study group, 66 patients (49.2 %) were diagnosed with GERD preoperatively, and HH was detected in 34 patients (25.3 %) intraoperatively. HH was treated by reduction in three patients, anterior repair in 28, and posterior repair in three. Only two patients (1.5 %) had symptoms of GERD at 6–12 months postoperatively. Conclusions Our results confirm that careful attention to surgical technique can result in significantly reduced occurrence of symptoms of GERD up to 12 months postoperatively, compared with previous reports of LSG in the literature.
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Affiliation(s)
- Jorge Daes
- Minimally Invasive Surgery Department, Clinica Bautista, Carrera 38 calle 71 esquina, Barranquilla, Colombia.
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