Paraesophageal Hernia and Reflux Prevention: Is One Fundoplication Better than the Other?

Andolfi, Ciro; Plana, Alejandro; Furno, Sara; Fisichella, P. Marco

doi:10.1007/s00268-017-4040-5

Cited by 17 publications

(4 citation statements)

References 58 publications

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“…15.7% radiological 0 57.5 4.4% conversions 7.8% morbidity Daigle et al [68] 2015 101 101 SC = 94 16.8% endoscopic/ radiological 0 10.9 22% morbidity 29.7% reflux Yates et al [69] 2015 11 HR 10 TG = 11 0% symptomatic N/A 3 2 readmissions 2 TG dislocations Higashi et al [70] 2017 To date, there is no consensus on the type of wrap and on the fixation of the fundoplication to the esophagus or the diaphragmatic pillars [28] . In a systematic review of the literature, including 24 studies, Andolfi et al [77] concluded that the preferred approach should be a total fundoplication when the esophageal motility is normal.…”

Section: Gastroesophageal Refluxmentioning

confidence: 99%

Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

Ugliono¹,

Rebecchi²,

Seno³

et al. 2021

Mini-invasive Surg

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Paraesophageal Hernia (PEH) is the protrusion of the stomach and/or other abdominal viscera into the mediastinum due to an enlargement of the diaphragmatic hiatus. The treatment of PEH is challenging: On the one hand, watchful waiting carries the risk of developing acute life-threatening complications requiring an emergency operation. On the other hand, elective repair of PEH has non-negligible morbidity and mortality rates, also due to the characteristics of PEH affected patients, who are generally elder and frail. A review of the literature is presented to highlight strategies that can be adopted to minimize early and long-term complications after PEH surgical repair. The laparoscopic approach has been shown to provide reduced hospital stay, postoperative morbidity and mortality, and overall costs compared to traditional open surgery, and it is currently considered the standard approach both to elective and emergency operations. The evidence suggests that strict adherence to surgical principles, such as hernia sac excision, extended mediastinal dissection of the esophagus, and tension-free crural repair with or without mesh are mandatory to achieve optimal surgical outcomes and reduce PEH recurrence rate. Different shapes, materials, and techniques of prosthetic repair and the use of relaxing incisions have been proposed, but long-term data are lacking, and no conclusions can be drawn regarding the ideal method of crural closure. When a short esophagus is recognized despite extensive mediastinal dissection, esophageal lengthening procedures are indicated. Systematic addition of a fundoplication is strongly encouraged, for either treating gastroesophageal reflux or reducing recurrence rate.

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Section: Gastroesophageal Refluxmentioning

confidence: 99%

Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

Ugliono¹,

Rebecchi²,

Seno³

et al. 2021

Mini-invasive Surg

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“…However, the disruption of the crural diaphragm during dissection of the gastroesophageal junction and the resulting risk of developing de-novo esophagitis may represent a strong rationale favoring routine fundoplication (37). Whether one fundoplication may be more suitable than another according to symptoms and objective findings on preoperative assessment has been investigated in a recent review by Andolfi et al (38). Unfortunately, the authors reported a paucity of highquality evidence in favor of a certain type of fundoplication over another in avoiding reflux and dysphagia following PEH repair.…”

Section: Gerdmentioning

confidence: 99%

Paraesophageal hernia: to fundoplicate or not?

Solomon¹,

Bekhor²,

Kashtan³

2021

Ann Transl Med

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The need for an antireflux procedure during repair of a paraesophageal hernia (PEH) has been the subject of a long-standing controversy. With most centers now performing routine fundoplication during PEH repair, high-quality data on whether crural repair alone or using a mesh may provide adequate antireflux effect is still scarce. We sought to answer to the question: "Is fundoplication routinely needed during PEH repair?". Our endpoints were (I) rates of postoperative gastroesophageal reflux disease (GERD) (either symptomatic or objectively assessed), (II) rates of recurrence, and (III) rates of postoperative dysphagia. We searched the MEDLINE, Cochrane, PubMed, and Embase databases for papers published between 1995 and 2019, selecting comparative cohort studies and only including papers reporting the rationale for performing or not performing fundoplication. Overall, nine papers were included for review. While four of the included studies recommended selective or no fundoplication, most of these data come from earlier retrospective studies. Higher-quality data from recent prospective studies including two randomized controlled trials recommended routine fundoplication, mostly due to a significantly lower incidence of postoperative GERD.However, only a relatively short follow-up of 12 months was presented, which we recognize as an important limitation. Fundoplication did not seem to result in reduced recurrence rates when compared to primary repair alone.

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“…Fundoplication, the wrap of the gastric fundus around the distal part of the esophagus, was introduced by Nissen[1] in 1956, as a surgical treatment of gastroesophageal reflux disease (GERD), and is currently considered as the operation of choice, when conservative approaches fail[2]. Since the extent of the plication was correlated with postoperative functional complications, various modifications ( e.g ., Hill, Toupet) of the original technique have been described[3-5]. Besides these, fundoplication has been, also, an important restoration element in other procedures, such as, Heller myotomy for esophageal achalasia[6].…”

Section: Introductionmentioning

confidence: 99%

Single incision laparoscopic fundoplication: A systematic review of the literature

Perivoliotis

Sarakatsianou

Tepetes

et al. 2019

WJGS

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BACKGROUND Fundoplication, was first introduced as a surgical treatment method of gastroesophageal reflux disease. Consequently, several modifications of this method have been described, whereas laparoscopic fundoplication was recently introduced. Although single incision (SI) fundoplication was considered as an alternative to the conventional laparoscopic approach, several studies reported an increased operation duration, and high rates of multiport conversion and incisional hernia. AIM To provide a current overview of the technical variations and the postoperative outcomes of patients submitted to SI fundoplication. METHODS The present systematic review of the literature was designed and conducted on the basis of the PRISMA guidelines. A systematic screening of the electronic scholar databases (Medline, Scopus and Web of Science) was performed. RESULTS Literature search resulted in the identification of 19 studies. Overall, 266, 137 and 110 SI Nissen, Dor and Toupet fundoplications were reported, respectively. In the majority of the trials, standard laparoscopic instruments were used. The left liver lobe was displayed through the use of forceps, graspers, retractors, drains or even glue. Both intra-corporeal and extracorporeal suturing was described. Mean operative time was 136.3 min. Overall complication rate was 5.2% and the rate of incisional hernia was 0.9%. No mortality was reported. CONCLUSION Due to the methodological heterogeneity and the lack of high quality studies comparing multi to single access techniques and the several variations, we conclude that further well designed studies are necessary, in order to evaluate the role of SI fundoplication.

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Paraesophageal Hernia and Reflux Prevention: Is One Fundoplication Better than the Other?

Cited by 17 publications

References 58 publications

Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

Paraesophageal hernia: to fundoplicate or not?

Single incision laparoscopic fundoplication: A systematic review of the literature

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