Hiatoplasty with Crura Buttressing versus Hiatoplasty Alone during Laparoscopic Sleeve Gastrectomy

Abstract

Introduction In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p = 0.006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p = 0.837) postoperatively became 9.5 and 2.4 (p = 0.071). In group A, there was no difference between pre- and postoperative scores (p = 0.279), whereas in group B, a highly significant difference was observed (p = 0.002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p = 0.0058). Conclusions In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG.

Concerns during Initiation of Sleeve Gastrectomy in a Laparoscopic Bariatric Program: A Single Surgeon’s Initial Experience and Review of Latest Literature

“…Recent studies show that patients with hiatal hernia and reflux experience significant symptom improvement after cruroplasty with buttressing of the crurae during sleeve gastrectomy. 19…”

Toward Operations in a Surgical Scenario: Characterization of a Microgripper via Light Microscopy Approach

“…For a representative example, MEMS-Technology based micro-accelerometers [4] are able to measure the heart wall motion of patients who have undergone coronary artery bypass graft surgery (CABG). Furthermore, there are many other applications where MEMS could be conveniently used to improve success in surgery, such as in laparoscopic sleeve gastrectomy (LSG) with cruroplasty [5], in surgical treatment of gastrointestinal stromal tumors of the duodenum [6] in colovesical fistula surgery with minimally invasive approach [7], in Endoluminal loco-regional resection by Transanal Endoscopic Microsurgery (TEM) [8][9][10], and in Low Rectal Anterior Resection (LAR) [11].…”

A Feasibility Study of a Novel Piezo MEMS Tweezer for Soft Materials Characterization

“…The system has shown promising results in terms of of versatility and applicability to different types of tissue [28]. Thanks to their high level of miniaturization, MEMS-Technology based tweezers can be employed also in minimal invasive [29][30][31] or gastrointestinal surgery [32], and more generally speaking, in endoluminal surgery, for example, in TEM [33][34][35].…”