Repair of Paraesophageal Hiatal Hernias–Is a Fundoplication Needed? A Randomized Controlled Pilot Trial

Müller‐Stich, Beat P.; Achtstätter, Verena; Diener, Markus K.; Gondan, Matthias; Warschkow, René; Marra, Francesco; Zerz, Andreas; Gutt, Carsten N.; Büchler, Markus W.; Linke, Georg R.

doi:10.1016/j.jamcollsurg.2015.03.003

Cited by 62 publications

(37 citation statements)

References 28 publications

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“…The need for antireflux surgery in addition to HH repair has also been discussed. A randomized controlled pilot study from Muller-Stich et al mentioned that fundoplication should be combined with a laparoscopic repair of HH to avoid postoperative gastroesophageal reflux [34]. The adaptation for surgical treatment is still debated.…”

Section: Discussionmentioning

confidence: 99%

Massive hiatal hernia involving prolapse of the entire stomach and pancreas resulting in pancreatitis and bile duct dilatation: a case report

2020

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Background: Hiatal hernia is defined by the permanent or intermittent prolapse of any abdominal structure into the chest through the diaphragmatic esophageal hiatus. Prolapse of the stomach, intestine, transverse colon, and spleen is relatively common, but herniation of the pancreas is a rare condition. We describe a case of acute pancreatitis and bile duct dilatation secondary to a massive hiatal hernia of pancreatic body and tail. Case presentation: An 86-year-old woman with hiatal hernia who complained of epigastric pain and vomiting was admitted to our hospital. Blood tests revealed a hyperamylasemia and abnormal liver function test. Computed tomography revealed prolapse of the massive hiatal hernia, containing the stomach and pancreatic body and tail, with peripancreatic fluid in the posterior mediastinal space as a sequel to pancreatitis. In addition, intrahepatic and extrahepatic bile ducts were seen to be dilated and deformed. After conservative treatment for pancreatitis, an elective operation was performed. There was a strong adhesion between the hernial sac and the right diaphragmatic crus. After the stomach and pancreas were pulled into the abdominal cavity, the hiatal orifice was closed by silk thread sutures (primary repair), and the mesh was fixed in front of the hernial orifice. Toupet fundoplication and intraoperative endoscopy were performed. The patient had an uneventful postoperative course post-procedure. Conclusion: A rare massive hiatal hernia, involving the stomach and pancreatic body and tail, can cause acute pancreatitis with bile duct dilatation. The etiology can be flexure of the main pancreatic and extrahepatic bile ducts. Symptomatic herniation is best treated with surgery. Elective surgery is thought to be safer than emergent surgery in patients with serious complications.

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Section: Discussionmentioning

confidence: 99%

Massive hiatal hernia involving prolapse of the entire stomach and pancreas resulting in pancreatitis and bile duct dilatation: a case report

2020

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“…Müller‐Stich et al compared the groups undergoing hiatus reinforcement using mesh with cardiophrenicopexy alone and the group undergoing reinforcement with fundoplication in an RCT. The postoperative incidence of esophagitis was 53.3% versus 16.7%, indicating the significance of fundoplication . Several reports have recommended anterior hemifundoplication for UDS .…”

Section: Outcomes Of Surgery Treatment For Lhhmentioning

confidence: 93%

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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“…174 A recent pilot trial by Muller-Stich et al showed a lesser degree of reflux and a less oesophagitis in patients where a fundoplication was added to the POH repair compared with those with a POH repair only. 172 Some authors advocate a selective approach to antireflux procedures, with preoperative testing (including manometry, pH-metry or endoscopy) and patient symptoms determining whether or not to add a fundoplication. 173 Others suggest always performing an antireflux procedure, but tailoring the type of fundoplication (eg, full or partial) depending on the patient.…”

Section: Oesophagogastroduodenoscopymentioning

confidence: 99%

How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery)

Pauwels

Boecxstaens

Andrews

et al. 2019

Gut

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ObjectiveAntireflux surgery can be proposed in patients with GORD, especially when proton pump inhibitor (PPI) use leads to incomplete symptom improvement. However, to date, international consensus guidelines on the clinical criteria and additional technical examinations used in patient selection for antireflux surgery are lacking. We aimed at generating key recommendations in the selection of patients for antireflux surgery.DesignWe included 35 international experts (gastroenterologists, surgeons and physiologists) in a Delphi process and developed 37 statements that were revised by the Consensus Group, to start the Delphi process. Three voting rounds followed where each statement was presented with the evidence summary. The panel indicated the degree of agreement for the statement. When 80% of the Consensus Group agreed (A+/A) with a statement, this was defined as consensus. All votes were mutually anonymous.ResultsPatients with heartburn with a satisfactory response to PPIs, patients with a hiatal hernia (HH), patients with oesophagitis Los Angeles (LA) grade B or higher and patients with Barrett’s oesophagus are good candidates for antireflux surgery. An endoscopy prior to antireflux surgery is mandatory and a barium swallow should be performed in patients with suspicion of a HH or short oesophagus. Oesophageal manometry is mandatory to rule out major motility disorders. Finally, oesophageal pH (±impedance) monitoring of PPI is mandatory to select patients for antireflux surgery, if endoscopy is negative for unequivocal reflux oesophagitis.ConclusionWith the ICARUS guidelines, we generated key recommendations for selection of patients for antireflux surgery.

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Repair of Paraesophageal Hiatal Hernias–Is a Fundoplication Needed? A Randomized Controlled Pilot Trial

Cited by 62 publications

References 28 publications

Massive hiatal hernia involving prolapse of the entire stomach and pancreas resulting in pancreatitis and bile duct dilatation: a case report

Massive hiatal hernia involving prolapse of the entire stomach and pancreas resulting in pancreatitis and bile duct dilatation: a case report

Minimally invasive surgery for large hiatal hernia

How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery)

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