Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair

Ponsky, Jeffrey L.; Rosen, Michael J.; Fanning, Alicia; Malm, Jennifer A.

doi:10.1007/s00464-002-8765-2

Cited by 84 publications

(3 citation statements)

References 26 publications

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“…As in a previous survey [5], there was no concordance among our experts regarding gastro-or fundo-phrenicopexy, probably due to the limited and conflicting evidence for this surgical adjunct in pHH repair [22][23][24][25]. Similarly, we found a mixed attitude towards short esophagus: 56% of participants were either unsure or disagreed that esophageal shortening represents a relevant finding during pHH repair.…”

Section: Discussioncontrasting

confidence: 46%

Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus

Gerdes

Schoppmann²,

Bonavina³

et al. 2023

Surg Endosc

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Aims There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as “recommended” or “discouraged” if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled “acceptable” (neither recommended nor discouraged). Results Seventy-two surgeons with a median (IQR) experience of 23 (14–30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15–36) and 40 (28–60) pHH-surgeries, respectively. After Delphi round 2, “recommended” strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified “discouraged” strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were “acceptable”. Conclusions This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.

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Section: Discussioncontrasting

confidence: 46%

Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus

Gerdes

Schoppmann²,

Bonavina³

et al. 2023

Surg Endosc

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“…The latter is thought to be caused by traction-induced neuropraxia or iatrogenic transsection of branches during extensive dissection of the hernia sac during repair of the large hiatal hernia. The symptomatic outcome after large hiatal hernia repair reported in previous studies generally emphasizes reflux-related symptoms, chest pain, general quality of life or a more general symptomatic outcome [12,13,14,15,17,18,19,21,22,23,24]. Reports on the frequency of dyspeptic symptoms after laparoscopic large hiatal hernia repair are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Heartburn, regurgitation, dysphagia and chest pain are the most frequently reported symptoms [12,13,14,15], but many patients have other upper abdominal symptoms like nausea, vomiting, postprandial discomfort and early satiation [16,17,18,19]. Although these symptoms are generally attributable to mechanical gastric emptying disturbances in patients with a large hiatal hernia, these may also be considered dyspeptic symptoms associated with large hiatal hernias as was previously described in patients with gastroesophageal reflux disease as well.…”

Section: Introductionmentioning

confidence: 99%

Dyspeptic Symptoms after Laparoscopic Large Hiatal Hernia Repair and Primary Antireflux Surgery for Gastroesophageal Reflux Disease: A Comparative Study

Furnée¹,

Draaisma²,

Hazebroek³

et al. 2010

Dig Surg

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Background: Several patients with gastroesophageal reflux disease suffer from functional dyspepsia. After laparoscopic Nissen fundoplication, these symptoms persist in a substantial number of patients. We hypothesized that, due to a higher chance of vagal nerve impairment during extensive hernia sac resection and esophageal mobilization, dyspeptic symptoms are more frequent after laparoscopic large hiatal hernia (types II–IV) repair than after primary antireflux surgery. Methods: From January 2003 to December 2007, 60 consecutive patients who primarily underwent an antireflux fundoplication for gastroesophageal reflux disease and 22 consecutive patients who had large hiatal hernia repair with fundoplication for concomitant gastroesophageal reflux disease were included. According to a system combining frequency and severity, patients scored 8 dyspeptic symptoms. Additionally, symptoms presenting preoperatively were scored according to the Visick grading system. Results: In 43 of the 49 available patients (87.8%) who primarily underwent antireflux surgery and in all 20 available patients who had hiatal hernia repair, preoperative symptoms resolved or improved. Mean symptom scores of all dyspeptic symptoms after surgery were comparable between both cohorts. General quality of life was equal in both cohorts. Conclusion: After laparoscopic large hiatal hernia repair, dyspeptic symptoms were present in similar frequencies as after primary antireflux surgery.

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Mesh in the Hiatus

Targarona¹

2004

Arch Surg

109

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To analyze the experience acquired to date on the use of prosthetic mesh to prevent recurrence after laparoscopic repair of paraesophageal hernia. Data Sources: Current English-language literature review. Study Selection: Case reports, series, and opinion articles on the use of mesh for paraesophageal hernia repair. Data Extraction and Synthesis: Study type and results were analyzed. Most articles were short case series. Few comparative or randomized trials assessing the procedure have been published to date. The information available showed that the use of a mesh for hiatal repair was safe and prevented recurrence. However, data on the longterm results were lacking, and infrequent but severe complications may arise. Conclusions: The mesh should be used selectively, and the decision to proceed should be based on clinical experience. In light of the evidence available, however, it appears to be safe, and the fears expressed in the past have not been confirmed.

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Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair

Cited by 84 publications

References 26 publications

Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus

Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus

Dyspeptic Symptoms after Laparoscopic Large Hiatal Hernia Repair and Primary Antireflux Surgery for Gastroesophageal Reflux Disease: A Comparative Study

Mesh in the Hiatus

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