Role of fundoplication in treatment of patients with symptoms of hiatal hernia

Li, Zhitong; Ji, Feng; Han, Xinwei; Yuan, Lili; Wu, Zhengyang; Xu, Miao; Peng, De-lu; Wang, Zhonggao

doi:10.1038/s41598-019-48740-x

Cited by 16 publications

(11 citation statements)

References 30 publications

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“…The prevalence of elderly patients with giant hiatal hernia continues to rise with increasing life expectancy in an ageing population (11). Some studies consider elderly patients undergoing giant hiatal hernia surgery to be at higher risk of complications and mortality because of their advanced age and comorbidities (25,26). Gangopadhyay reported that an older patient group (≥75 years) undergoing laparoscopic paraesophageal hernia repair were associated with more complications than other groups (65-74 years group and <65 years group) (27).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic repair of giant hiatal hernia for elderly patients

Guan¹,

Nie²,

Yuan³

et al. 2021

Ann Transl Med

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Background: Giant hiatal hernias are more common in older patients and can significantly reduce their quality of life. However, open surgery for patients of advanced age is thought to be associated with high morbidity and mortality. The aim of this retrospective study was to evaluate the safety of laparoscopic giant hiatal hernia repair for elderly patients as compared to younger patients.Methods: From January 2015 to January 2020, 152 consecutive patients underwent laparoscopic mesh repair of giant hiatal hernia. Two cases of missing follow up were excluded. Patients were divided into an elderly group (N=62, age ≥75) and a younger group (N=88, age <75). Interrupted non-absorbable suture was applied for crus closure and as an additional reinforcement, the mesh was fixed with absorbable tacks or medical glue. Procedure-related complications, score-based variation tendency of symptoms, gastrointestinal quality of life index (GIQLI), mortality, recurrence rate, hemoglobin, and the use of PPI were investigated.Results: All patients underwent the procedure uneventfully. Dor fundoplication was used in 39 patients (62.9%) in the elderly group and 44 (50.0%) in the younger group and no case was converted to open.While the elderly group had a significantly higher percentage of ASA Class level 3 and cardiovascular and cerebrovascular diseases as compared to the younger group, the two groups had similar operative times, intraoperative blood loss, and percentage of intrathoracic stomach. Elderly group patients tended to have higher perioperative complications including pneumonia (3.2%) and atelectasis (3.2%) without statistical significance, as well as transfer to the intensive care unit compared, to younger patients (9.7% vs. 3.2%; P=0.144). The mean post-operative hospital stay was also significantly shorter in the younger group (2.8 days) compared with the elderly group (3.5 days; P=0.001). There was no mortality, recurrence, meshrelated complications such as visceral erosion, adhesion, or severe dysphagia during follow up in the two groups, and both groups demonstrated significant improvement in GIQLI scores and hemoglobin. The percentage of patients who needed PPI was also reduced in both groups.Conclusions: Laparoscopic mesh repair of giant hiatal hernia for elderly patients is safe and effective when performed at experienced centers.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic repair of giant hiatal hernia for elderly patients

Guan¹,

Nie²,

Yuan³

et al. 2021

Ann Transl Med

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“…The authors concluded that adding routine fundoplication is reasonable, without adding significant morbidity or side effects. The largest randomized controlled trial was conducted by Li et al (27). A total of 122 patients were randomly assigned to AR or NAR.…”

Section: Evidence-based Data Supporting Routine Fundoplicationmentioning

confidence: 99%

“…These results are quite similar to the more recent comparative studies included in our review. Overall postoperative GERD rates were found in 16-45% of NAR patients and in 0-19% of AR patients (19)(20)(21)(22)(23)(24)(25)(26)(27). While four of the included studies recommended selective or no fundoplication, most of these data come from earlier retrospective studies, and the presence of an important selection bias should be considered.…”

Section: Gerdmentioning

confidence: 99%

“…While four of the included studies recommended selective or no fundoplication, most of these data come from earlier retrospective studies, and the presence of an important selection bias should be considered. Higherquality data from recent prospective series including two randomized controlled trials recommended routine fundoplication, mostly due to a significantly lower incidence of postoperative GERD (24,26,27). Importantly, the abovementioned prospective studies were limited from a short follow-up of 1 year.…”

Section: Gerdmentioning

confidence: 99%

“…Data from early experience with laparoscopic PEH repair and fundoplication was contrasting, with some studies reporting no recurrences on esophagogram (40) and others reporting recurrence rates up to 42% (41,42). Looking at the included studies, data on recurrence rates was available in only 6 papers, and only 4 studies reported recurrence rates for each cohort (19)(20)(21)24,26,27). In the series from Morris-Stiff et al, no patients suffered from recurrence (21).…”

Section: Recurrencementioning

confidence: 99%

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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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Evidence mapping on how to perform an optimal surgical repair of large hiatal hernias

Nickel,

Müller,

Cizmic

et al. 2023

Langenbecks Arch Surg

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Background Symptomatic and large hiatal hernia (HH) is a common disorder requiring surgical management. However, there is a lack of systematic, evidence-based recommendations summarizing recent reviews on surgical treatment of symptomatic HH. Therefore, this systematic review aimed to create evidence mapping on the key technical issues of HH repair based on the highest available evidence. Methods A systematic review identified studies on eight key issues of large symptomatic HH repair. The literature was screened for the highest level of evidence (LE from level 1 to 5) according to the Oxford Center for evidence-based medicine’s scale. For each topic, only studies of the highest available level of evidence were considered. Results Out of the 28.783 studies matching the keyword algorithm, 47 were considered. The following recommendations could be deduced: minimally invasive surgery is the recommended approach (LE 1a); a complete hernia sac dissection should be considered (LE 3b); extensive division of short gastric vessels cannot be recommended; however, limited dissection of the most upper vessels may be helpful for a floppy fundoplication (LE 1a); vagus nerve should be preserved (LE 3b); a dorso-ventral cruroplasty is recommended (LE 1b); routine fundoplication should be considered to prevent postoperative gastroesophageal reflux (LE 2b); posterior partial fundoplication should be favored over other forms of fundoplication (LE 1a); mesh augmentation is indicated in large HH with paraesophageal involvement (LE 1a). Conclusion The current evidence mapping is a reasonable instrument based on the best evidence available to guide surgeons in determining optimal symptomatic and large HH repair.

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Role of fundoplication in treatment of patients with symptoms of hiatal hernia

Cited by 16 publications

References 30 publications

Laparoscopic repair of giant hiatal hernia for elderly patients

Laparoscopic repair of giant hiatal hernia for elderly patients

Paraesophageal hernia: to fundoplicate or not?

Evidence mapping on how to perform an optimal surgical repair of large hiatal hernias

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