Hiatal hernia recurrences after laparoscopic surgery: exploring the optimal technique

Akmaz, Berdel; Hameleers, A; Boerma, Evert-Jan G.; Vliegen, Roy F. A.; Greve, Jan; Meesters, Berry; Stoot, Jan H.M.B.

doi:10.1007/s00464-023-09907-w

Cited by 7 publications

(2 citation statements)

References 25 publications

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“…This small prosthetic strip is placed vertically over both hiatal pillars and was associated with lower recurrence rates in combination with additional anterior cruroplasty. Additionally, fewer mesh related complications were reported compared to other prosthetic meshes due to the smaller surface area [ 24 ]. It is safe to say further research is needed on both prosthetic and bio-absorbable reinforcement options to determine the optimal technique.…”

Section: Discussionmentioning

confidence: 99%

Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia

Geerts,

de Haas,

Nieuwenhuijs

2024

Surg Endosc

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Background Hiatal Hernia (HH) is a common structural defect of the diaphragm. Laparoscopic repair with suturing of the hiatal pillars followed by fundoplication has become standard practice. In an attempt to lower HH recurrence rates, mesh reinforcement, commonly located at the posterior site of the esophageal hiatus, has been used. However, effectiveness of posterior mesh augmentation is still up to debate. There is a lack of understanding of the mechanism of recurrence requiring further investigation. We investigated the anatomic location of HH recurrences in an attempt to assess why HH recurrence rates remain high despite various attempts with mesh reinforcement. Methods A retrospective case series of prospectively collected data from patients with hiatal hernia repair between 2012 and 2020 was performed. In total, 54 patients with a recurrent hiatal hernia operation were included in the study. Video clips from the revision procedure were analyzed by a surgical registrar and senior surgeon to assess the anatomic location of recurrent HH. For the assessment, the esophageal hiatus was divided into four equal quadrants. Additionally, patient demographics, hiatal hernia characteristics, and operation details were collected and analyzed. Results 54 patients were included. The median time between primary repair and revision procedure was 25 months (IQR 13–95, range 0–250). The left-anterior quadrant was involved in 43 patients (80%), the right-anterior quadrant in 21 patients (39%), the left-posterior quadrant in 21 patients (39%), and the right-posterior quadrant in 10 patients (19%). Conclusion In this study, hiatal hernia recurrences occured most commonly at the left-anterior quadrant of the hiatus, however, posterior recurrences were not uncommon. Based on our results, we hypothesize that both posterior and anterior hiatal reinforcement might be a suitable solution to lower the recurrence rate of hiatal hernia. A randomized controlled trial using a circular, bio-absorbable mesh has been initiated to test our hypothesis.

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Section: Discussionmentioning

confidence: 99%

Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia

Geerts,

de Haas,

Nieuwenhuijs

2024

Surg Endosc

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“…Following laparoscopic repair of large hiatal hernias, recurrence rates as high as 60% have been reported [6]. The causes of recurrence are multifactorial and may include failure to achieve sufficient intra-abdominal esophageal length, inadequate crural closure, preexisting medical conditions, and the size of the hiatal hernia [4,7].…”

Section: Introductionmentioning

confidence: 99%

Cruroplasty as a standalone treatment for recurrent hiatal hernia repair

Tran,

Putnam,

Harvey

et al. 2024

Hernia

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Purpose Following laparoscopic anti-reflux surgery (LARS), recurrence of hiatal hernia is common. Patients with symptomatic recurrence typically undergo revision of the fundoplication or conversion to magnetic sphincter augmentation (MSA) in addition to cruroplasty. However, patients with an intact fundoplication or MSA may only require repeat cruroplasty to repair their recurrent hiatal hernia. The purpose of this study is to compare outcomes following cruroplasty alone compared to full revision (i.e. redo fundoplication or MSA with cruroplasty) for the management of recurrent hiatal hernias. Methods A retrospective review of patients undergoing surgical revision of a symptomatic recurrent hiatal hernia between February 2009 and October 2022 was performed. Preoperative characteristics, intraoperative details, and postoperative outcomes were compared between patients undergoing cruroplasty alone versus full revision. Results A total of 141 patients were included in the analysis. 93 patients underwent full revision, and 48 patients underwent cruroplasty alone. The mean time between initial and revisional surgery was 8 ± 7.7 years. There was no significant difference in operative time or rates of intra-operative or post-operative complication between groups. Patients undergoing cruroplasty alone had a mean Gastroesophageal Reflux Disease Health Related Quality Life (GERD-HRQL) Questionnaire score of 9.6 ± 10.2 compared to a mean score of 8.9 ± 11.2 for full revision patients (p = 0.829). Recurrence rates following revision was 10.4% for cruroplasty alone patients and 11.8% in full revision patients (p > 0.999). Conclusion In patients with intact fundoplication or MSA, cruroplasty alone results in similar post-operative outcomes compared to full revision for recurrent hiatal hernia.

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Fundoplication at the time of paraesophageal hernia repair does not decrease the rate of hernia recurrence or postoperative reflux

Lyons,

Chatha,

Boutros

et al. 2024

Surg Endosc

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Hiatal hernia recurrences after laparoscopic surgery: exploring the optimal technique

Cited by 7 publications

References 25 publications

Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia

Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia

Cruroplasty as a standalone treatment for recurrent hiatal hernia repair

Fundoplication at the time of paraesophageal hernia repair does not decrease the rate of hernia recurrence or postoperative reflux

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