Laparoscopic management of large hiatus hernia: five-year cohort study and comparison of mesh-augmented versus standard crura repair

Asti, Emanuele; Lovece, Andrea; Bonavina, Luigi; Milito, Pamela; Sironi, Andrea; Bonitta, Gianluca; Siboni, Stefano

doi:10.1007/s00464-016-4897-7

Cited by 48 publications

(25 citation statements)

References 20 publications

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“…Closing hiatus routinely can reduce this complication by upto 80% [11]. Closing large hiatuses with grafts has been reported to prevent recurrences [12,13]; however, complications such as migration into lumen can be experienced with graft use [14].…”

Section: Discussionmentioning

confidence: 99%

“…Biological meshes have been developed against organ resection and loss that occurs secondary to mesh erosion [22]. It has been stressed that mesh problems that have been reported to occur at a low rate do not constitute any major contraindication for mesh use [13]. Mesh fixation can be accomplished with various different materials including sutures, metal fixators and glues [23].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results

Kafadar¹,

Yalaza²,

Türkan³

et al. 2016

CIM

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Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results AbstractPurpose: In this study we report early-term results of laparoscopic Nissen fundoplication with mesh hiatoplasty that we perform to treat gastroesophageal reflux disease. Methods:We retrospectively reviewed the medical records of 68 patients who underwent laparoscopic Nissen fundoplication with mesh hiatoplasty at our clinic. Thirty-six (53%) patients were male and 32 (47%) were female. The mean age of the study population was 46.1 (25-72) years. All patients underwent endoscopy, esophagus pH metry and manometry before the operation. All operations were performed under general anesthesia using five ports. In addition to Nissen fundoplication, all patients also underwent polypropylene mesh placement.Results: Preoperatively, all patients reported a burning sensation in the chest and regurgitation of the stomach contents up into the mouth. The mean time from symptom onset to operation was 28 (6-84) months. All patients were diagnosed with esophagitis in the preoperative endoscopic examination. The mean operative time was 80 (40-125) minutes, the median duration of hospital stay was 1.2 (1-4) days and the median follow-up time was 12 (2-30) months. Functional outcome was excellent in 65% of patients, good in 24.5%, moderately good in 7% and poor in 3.5%. Conclusion:Fundoplication with mesh hiatoplasty is a surgical procedure performed for the traetment of gastroesophageal reflux disease and hiatal hernia. Surgery can be safely carried out with low morbidity and mortality rates and constitutes an alternative to long-term drug therapy. We believe that this operation is beneficial since it reduces the rate of recurrences to a significant degree.SUPPLEMENT

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results

Kafadar¹,

Yalaza²,

Türkan³

et al. 2016

CIM

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“…There are two statements on it in the guidelines. One is, “The use of mesh for reinforcement of large hiatal hernia repairs leads to decreased short‐term recurrence rates.” Although mesh involves complications, it reduces short‐term recurrence rates . The other statement is, “There are inadequate long‐term data on which to base a recommendation either for or against the use of mesh at the hiatus.” Recently, a report using the data from a period of 48 months following surgery indicated that the use of mesh decreased the recurrence rate.…”

Section: Outcomes Of Surgery Treatment For Lhhmentioning

confidence: 99%

“…In addition, the suture and tacking during mesh fixation may involve serious complications such as cardiac tamponade. Recently, there have been fewer reports on serious complication compared to the past . It has also been reported that not using prosthesis mesh resulted in a low recurrence rate and good treatment outcomes …”

Section: Outcomes Of Surgery Treatment For Lhhmentioning

confidence: 99%

Minimally invasive surgery for large hiatal hernia

Omura

Tsuboi

Yano

2019

Annals of Gastroent Surgery

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The majority of large hiatal hernias are paraesophageal hiatal hernias (PEH). Once prolapse of the stomach to the chest cavity reaches a high degree, it is called an intrathoracic stomach. More than 25 years have elapsed since laparoscopic surgery was carried out as minimally invasive surgery for PEH. The feasibility and safety thereof has nearly been established. PEH may cause serious complications such as strangulation and perforation. The outcome of elective repair of PEH is better than emergent repair, so we should carry out elective repair as much as possible. Although not a major clinical problem, following PEH repair the rate of anatomical recurrence increases with age. In order to reduce the recurrence rate, mesh reinforcement by crural repair has been widely performed. Although this improves the short‐term outcomes, the long‐term outcomes are unclear. For PEH repair, fundoplication and gastropexy are believed desirable. We should select the procedure associated with a lower incidence of dysphagia and so on following surgery. While relaxing incision is useful for primary tension‐free closure, it has not contributed to improvement in the recurrence rate.

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“…Some studies seem to encourage mesh placement mainly due to decreased short-term recurrence rates compared to suture hiatal repair [17][18][19]. Others suggest that primary crural repair with or without mesh reinforcement, does not alter the recurrence rate and the five-year recurrence-free probability is similar in both groups [20]. The limited available information does not allow us to make conclusions about the longterm efficacy of mesh in this setting.…”

Section: Editorialmentioning

confidence: 99%

Paraoesophageal Hernias: A Surgical Perspective

Farhangmehr¹,

Liakakos²,

Àlex³

et al. 2017

J Gastrointest Dig Syst

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EditorialHiatal hernias refer to the condition where intra-abdominal structures herniate into the mediastinum through the oesophageal hiatus. They occur in about 10% of the population. Hiatal hernias are classified in 4 types. Type I or sliding hernia represents 85%-90% of all hiatal hernias. It results from laxity and loss of coherence of the phreno-oesophageal membrane. The gastro-oesophageal junction (GOJ) is displaced above the diaphragm while the fundus remains below the GOJ. Hiatal hernias type II, III and IV or collectively known as paraesophageal hernias represent about 10%-15% of hiatal hernias. Type II hernia results from a localized defect in the phrenooesophageal membrane. The gastric fundus herniates into the mediastinum, while the GOJ remains fixed to the preaortic fascia and the median arcuate ligament. Type III paraoesophageal hernias have elements of both types I and II and have both the GOJ and the fundus herniating through the hiatus. Type IV hiatus hernia is associated with a large defect in the diaphragm defined by the presence of organs other than the stomach in the hernia sac commonly being the transverse colon, spleen, pancreas or small bowel.Paraoesophageal hernia is a condition mainly seen in the elderly population. In most large series, presentation with a median age of 65 to 75 years appears to be the rule [1]. Risk factors for developing hiatal hernia include age greater than 50, BMI>25 and male gender [2]. About 50% of cases are asymptomatic and the hernia is an incidental finding on imaging or endoscopy. In sliding hernias reflux symptoms such as heartburn and regurgitation are more frequent; whilst in paraoesophagheal hernias common symptoms include epigastric or substernal pain, postprandial fullness, dysphagia, nausea, vomiting and dyspnoea. Microcytic anaemia can be present secondary to erosions of the gastric mucosa. Acute symptoms due to gastric outlet obstruction/ gastric volvulus, uncontrolled bleeding, strangulation, perforation, and respiratory compromise are indications for urgent surgery.Hiatus hernia can be an incidental finding on a chest X-ray where the gastric bubble can be seen in the chest. On barium swallow the presence of more than 2 cm separation between the B ring (level of squamocolumnar junction) and the diaphragm suggests a sliding hiatus hernia. If a B ring is not evident on barium swallow (absent in 85% of individuals), the demonstration of at least three rugal folds traversing the diaphragm is diagnostic of a sliding hiatus hernia [3]. In paraoesophageal hernias there is evidence of the fundus herniating into the mediastinum. On endoscopy a sliding hernia is defined as a greater than 2 cm distance between the squamocolumnar junction and the diaphragmatic impression on the stomach [3]. In paraoesophageal hernias the hernia can be visualised on retroflexion (J manoeuvre) of the endoscope that reveals a portion of the stomach, herniating upward through the diaphragm, adjacent to the endoscope [3]. Another indirect indicator of paraoesophageal hernia that sh...

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Laparoscopic management of large hiatus hernia: five-year cohort study and comparison of mesh-augmented versus standard crura repair

Abstract: Laparoscopic repair of large hiatal hernia is effective and durable. Crura reinforcement with a resorbable synthetic mesh is safe and may protect from early anatomical recurrence.

Cited by 48 publications

References 20 publications

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results

Minimally invasive surgery for large hiatal hernia

Paraoesophageal Hernias: A Surgical Perspective

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