Laparoscopic Paraesophageal Hernia Repair

Angeramo, Cristian A.; Schlottmann, Francisco

doi:10.1097/sla.0000000000004913

Cited by 31 publications

(16 citation statements)

References 40 publications

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“…38,39 Displacement of the gastroesophageal junction to the chest affects the reflux-protective function of the lower esophageal sphincter, with gastroesophageal reflux as a result, and the larger the hiatal hernia the more severe becomes the reflux. 6 Accordingly, hiatal closure is considered to be a critical component in the surgical treatment of GERD, 2,7,8 albeit hiatal hernia repair by cruroplasty alone does not offer control of GERD. [40][41][42] Our finding of worse GSRS reflux scores in patients with hiatal hernia recurrence reinforces the significance of the durability of the anatomical reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Some aspects of this article deserve comments. Most of the studies mentioned in the discussion evaluated the use of mesh for the repair of large paraesophageal hernias, a different disease and a more complex operation, [3][4][5][6] whereas in this study, only patients mostly with small sliding hernias were included. 1 In addition, only 40% of the original patients were assessed for hiatal hernia recurrence at the long-term follow-up.…”

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confidence: 99%

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Hiatal Hernia Repair With Tension-Free Mesh or Crural Sutures Alone in Antireflux Surgery

Analatos,

Håkanson,

Ansorge

et al. 2024

JAMA Surg

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ImportanceAntireflux 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.ObjectiveTo assess the long-term anatomical and functional outcomes of using a mesh for hiatal hernia repair in patients with GERD.Design, Setting, and ParticipantsA 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.InterventionsClosure of the diaphragmatic hiatus with crural sutures alone vs a tension-free technique using a nonabsorbable polytetrafluoroethylene mesh (Bard CruraSoft).Main Outcomes and MeasuresThe 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.ResultsOf 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 RelevanceFindings 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 RegistrationClinicalTrials.gov Identifier: NCT05069493

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Hiatal Hernia Repair With Tension-Free Mesh or Crural Sutures Alone in Antireflux Surgery

Analatos,

Håkanson,

Ansorge

et al. 2024

JAMA Surg

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“…We congratulate both Angeramo CA and Petric J 1,2 again for their excellent work, and we hope that their contribution will be useful to guide the treatment of PEH.…”

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confidence: 92%

“…We read with great interest the recently published Systematic Review and Meta-analysis by Angeramo CA and Petric J, 1,2 which both unanimously indicate that, patients undergoing paraesophageal hernia (PEH) repair have similar recurrence rate with either mesh reinforcement or suture only repair. Therefore, the 2 studies pose a few important questions: why does mesh repair fall in decreasing recurrence rate in PEH repair?…”

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confidence: 99%