Defining recurrence after paraesophageal hernia repair: Correlating symptoms and radiographic findings

Lidor, Anne O.; Kawaji, Qingwen; Stem, Miloslawa; Fleming, Richard M; Schweitzer, Michael; Steele, Kimberley E.; Marohn, Michael R.

doi:10.1016/j.surg.2013.03.015

Cited by 50 publications

(28 citation statements)

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“…As previously reported, it has been clearly established that the size and type of hernia before surgery are the main factors for recurrence. 13 It is very important to consider the size of the herniated stomach and the hernia surface area, because as suggested by Koch et al, 14 Granderath et al, 15,16 and Braghetto et al, 17 hiatal hernias larger than 10 cm in diameter have a higher rate of recurrence. The Nebraska group presented a follow-up of 209 patients in which they demonstrated high recurrence rates that increased over time from 16% at 1 year up to 40% after 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…In the published literature, the size of a recurrent hernia is very variable, with a mean size of 4 cm (range, 2-7 cm in diameter) and with a recurrence rate ranging from 27% to 57%, without correlation between the size of the recurrent hernia and postoperative symptoms. 1,[11][12][13] The range of asymptomatic recurrent hernia after laparoscopic repairs ranges from 30% to 95% of patients. In the study by Koch et al, 14 95% of patients were asymptomatic, and reherniation was only detected radiologically.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is no consensus, some authors have suggested criteria pertaining to issues of size, presence of symptoms, or impact on quality of life. 12,13 The purpose of this study was to identify clinical, endoscopic, or radiologic characteristics in order to define when a true recurrence should be diagnosed.…”

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confidence: 99%

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Thinking About Hiatal Hernia Recurrence After Laparoscopic Repair: When Should It Be Considered a True Recurrence? A Different Point of View

Braghetto

Lanzarini

Musleh

et al. 2018

International Surgery

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Background: High rates of recurrence after laparoscopic hiatal hernia repair have been published. Most of these recurrences are asymptomatic and only diagnosed by endoscopic or radiologic studies. The definition of hiatal hernia recurrence is still under discussion.Objective: This study aimed to define a true hiatal hernia recurrence using a score and classification criteria considering the presence of symptoms and size of the recurrence.Patients and Methods: A total of 153 patients with giant hiatal hernia larger than 10 cm in diameter underwent an operation using a laparoscopic approach. Of these patients, 129 had a complete follow-up (3-5 years) after surgery, and they were the only ones included in this study. The IT system of our hospital was our database for data registration. A score and classification were designed for definition of a ''true'' hiatal hernia recurrence, based on postoperative symptoms and the presence or not of a hiatal hernia in both radiologic and endoscopic evaluations.Results: Hiatal hernia recurrence based on endoscopic and/or radiologic hiatal hernia was found in 55 patients (42.6%), and only 28 of them (50.9%) had recurrent symptoms. Applying the score and proposed classification, no recurrence was considered in 18 patients (13.9%). Symptomatic and true recurrence were considered in 22.9% of patients (29 patients). Reoperation was needed for 7 patients (5.4%) because of symptomatic and radiologic recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Thinking About Hiatal Hernia Recurrence After Laparoscopic Repair: When Should It Be Considered a True Recurrence? A Different Point of View

Braghetto

Lanzarini

Musleh

et al. 2018

International Surgery

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“…The PEH cohort has been described in detail previously. 12 All data were prospectively collected on a standardized collection form and maintained in an electronic database. Patient demographics, surgical history, baseline comorbidities and symptoms (BMI, smoking status, diabetes mellitus, pulmonary disease, preoperative dysphasia, heartburn, and pain), operative details, postoperative course of care (reoperation and length of hospital stay), and postoperative clinic visits, including radiographic studies, were collected.…”

Section: Data Source and Study Populationmentioning

confidence: 99%

“…A common thread among published studies, however, has been identification of PEH recurrence as an asymptomatic radiographic finding that bears no correlation with the symptomatic improvement conferred by PEH repair. 12 Moreover, this clinical efficacy appears to endure even in the face of radiographic hernia recurrence.…”

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confidence: 99%

Long-term Quality of Life and Risk Factors for Recurrence After Laparoscopic Repair of Paraesophageal Hernia

et al. 2015

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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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Defining recurrence after paraesophageal hernia repair: Correlating symptoms and radiographic findings

Cited by 50 publications

References 28 publications

Thinking About Hiatal Hernia Recurrence After Laparoscopic Repair: When Should It Be Considered a True Recurrence? A Different Point of View

Thinking About Hiatal Hernia Recurrence After Laparoscopic Repair: When Should It Be Considered a True Recurrence? A Different Point of View

Long-term Quality of Life and Risk Factors for Recurrence After Laparoscopic Repair of Paraesophageal Hernia

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

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