Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty

Abstract

In primary intervention, recurrence of hiatal hernia is more likely the larger the HSA is. The size of the hiatus is a major contributing factor to the possibility of reherniation. After failed primary hiatal closure, the size of the hiatal defect is no marker for the possibility of reherniation.

Perioperative outcomes of surgical procedures for symptomatic fundoplication failure: a retrospective case–control study

“…A recently published comprehensive review determined that of 762 pooled cases from multiple case series, hiatal hernia was the most common mechanism of failure (44%) [10]. The risk of hiatal closure failure after primary fundoplication seems to be directly related to the size of the hiatal defect at the time of primary surgery [11] and/or the presence of diaphragm ''stressors'' in the perioperative period (gagging, belching, and vomiting) [12,13]. The diaphragm repair is clearly the Achilles heel of a fundoplication, at least when it comes to durability.…”

Multiplanar MDCT measurement of esophageal hiatus surface area: association with hiatal hernia and GERD

“…Knowledge of hiatus size is also important in antireflux surgery. A large pre-operative hiatus is associated with increased rate of surgical failure, and some surgeons advocate selecting hiatal closure technique based on hiatus size [9–12]. The relationship between hiatal widening and HH is complex.…”

Diaphragmatic crural augmentation utilising cross-linked porcine dermal collagen biologic mesh (Permacol™) in the repair of large and complex para-oesophageal herniation: a retrospective cohort study

“…Cruroplasty has long been held to be an integral part of the surgery. Larger hernias are, however, more prone to develop recurrence, even with mesh reinforcement [18]. As with other hernia repairs, this probably relates to tension that increases as defect size increases.…”