Medium-term durability of giant hiatus hernia repair without mesh

Abstract

Introduction This is the second report on objective review of 100 patients who underwent composite fundoplication-cardiopexy for repair of giant hiatus hernia (GHH) at a median of 24 months following surgery. Outcomes were objective follow-up by endoscopy and quality of life (QoL) by Gastrointestinal Quality of Life Index (GIQLI), modified Visick scores and dysphagia scores. The initial report for this cohort suggested a low objective recurrence rate (9%) and substantial improvements in QoL indices. Methods The rate of hernia recurrence was assessed with Kaplan-Meier analysis and covariates were analysed with the Cox proportional hazards model. Paired t-tests and related samples Wilcoxon signed-rank tests were used to compare QoL scores. Unpaired data were compared with the independent samples t-test and Mann-Whitney U test. Results Objective review was obtained in 97% of the patients. There were five recurrences of hernias that had a vertical height of >2cm from the diaphragmatic hiatus, with three patients requiring reoperation for severe dysphagia. Small recurrences (<2cm) occurred in 20 patients. The median time to recurrence was 40 months (95% confidence interval: 34-46 months). At two years, recurrence of any size had occurred in 24% of cases. At follow-up review (median: 27 months), the mean GIQLI score was 109 (p=0.279), the median modified Visick score was 2 (p=0.954) and the median dysphagia score was 41 (p=0.623). There was no evidence that the GIQLI score (p=0.089), the modified Visick score (p=0.339) or the dysphagia score (p=0.445) changed significantly after recurrence. Conclusions There was a sustained improvement in overall QoL and reflux scores after GHH repair. QoL scores showed persistent improvement in reflux and overall health, even in the subgroup with recurrence. The majority (80%) of recurrences were small and recurrent herniation did not appear to significantly change QoL. The rates of recurrence and QoL are comparable with those for other methods of repair.

Does composite repair of giant paraoesophageal hernia improve patient outcomes?

“…Reoperation rates were low (7%), which is similar to previous reports 21,29 . Revision surgery was offered to patients with severe persistent symptoms resistant to medical treatment.…”

“…Median time to recurrence diagnosis was 22.5 months (range 2–99 months, mean 30.5 months), which is within the range reported for suture, synthetic and biologic mesh repairs 21,22,29,30 . Median time to recurrence in this group corresponded with time of worsening of QoL scores in patients with recurrence.…”

Follow Up Data of MRI-Visible Synthetic Meshes for Reinforcement in Large Hiatal Hernia in Comparison to None-Mesh Repair—A Prospective Cohort Study

“…Thus, a pre/post comparison is missing in this instance. However, long-term quality of life is markedly higher in the mesh group as compared to the non-mesh group, and is better or comparable to literature [e.g., (28–30)]. An additional limitation of this study are missing image-based diagnostics for the follow-up of the non-mesh group, for whom the follow-up entailed only clinical diagnostics and no barium swallow and/or MRI as compared to the mesh group.…”

Protocol for Randomised Controlled Feasibility Study Comparing Cruroplasty with Circumferential DynaMesh-HIATUS® Versus Suture-Only Repair for Large Hiatus Hernias

“…To mitigate this, some surgeons have tried modifications to the suture technique. One expert centre initially reported low recurrence rates of 6% with this; however, this rose to 24% at 2 years, and 50% by 10 years [11][12][13]. For these reasons, other surgical techniques have been sought to improve the durability of sutureonly repairs, including Collis gastroplasty to lengthen the oesophagus and diaphragm-relaxing incisions [14].…”