Is fundoplication necessary after paraesophageal hernia repair? A meta-analysis and systematic review

Clapp, Benjamin; Hamdan, Marah; Mandania, Roshni; Kim, Ji-Soo; Gamez, Jesus; Hornock, Sasha; Vivar, Andres; Dodoo, Christopher; Davis, Brian R.

doi:10.1007/s00464-022-09024-0

Cited by 10 publications

(5 citation statements)

References 35 publications

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“…Most HHR-LNF patients were fully or partially satisfied with the symptom relief following surgery in contrast to patients after HHR (81.8% vs. 47.2%, P < 0.001). Clapp et al performed MA-RCTs and non-RCTs that also favored that additional fundoplication should be routinely performed [ 31 ].…”

Section: Addition Of a Fundoplicationmentioning

confidence: 99%

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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Section: Addition Of a Fundoplicationmentioning

confidence: 99%

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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“…На нашу думку, причини невдач застосованих антирефлюксних втручань пов'язані з недоліками їх виконання, а саме з руйнуванням складових фізіологічної кардії: при мобілізації фундального відділу шлунка руйнуються діафрагмально-фундальна, діафрагмально-селезінкова, шлунково-селезінкова та шлунково-підшлункова зв'язки; новоутворена манжета, яка обгортає стравохід, розташовується нефізіологічно і може призводити до дисфагії; руйнується газовий міхур шлунка, кут Гіса, клапан Губарєва, діафрагмальний компонент механізму замикання фізіологічної кардії; руйнується відмежування середостіння та абдомінального відділу стравоходу від черевної порожнини, що призводить до gas-bloat-синдрому [2,[16][17][18].…”

Section: таблиця 3 -рецидиви гсод у післяопераційному періоді в обсте...unclassified

Causes of failures of known methods of antireflux laparoscopic interventions for hiatal hernias

Shevchenkо

Prolom

Babii

et al. 2023

GASTRO

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Background. The objective: to compare the effectiveness and safety of known laparoscopic antireflux interventions in the treatment of hiatal hernia and to detect the causes for their failure in a retrospective study. Materials and methods. In a retrospective comparative study, the long-term results of using the main methods of laparoscopic plastic surgery for hiatal hernias of various types and degrees were analyzed. Seventy-four (56.5 %) patients who underwent Nissen fundoplication were included in group 1. Group 2 consisted of 37 (28.2 %) people who underwent Toupet fundoplication and group 3 included 20 (15.3 %) patients who underwent Dor fundoplication. The study includes patients operated in the clinic of the institute over a 7-year period, with the possibility of clinical evaluation of long-term results and the exclusion of factors affecting the results of plastic surgery. All patients underwent X-ray and endoscopic examinations of the esophagus, stomach, duodenum, as well as manometry. Results. When analyzing the complaints of patients from groups 1–3 in the postoperative period, it can be noted that the most statistically significant indicators were dysphagia, regurgitation, cough, heartburn, bloating, stomach heaviness, pain behind the sternum (p < 0.05, exact F test). During endoscopic examination, reflux esophagitis was detected in 16 (21.6 %) patients of group 1, in 7 (18.9 %) of group 2, and in 2 (10.0 %) patients of group 3. Erosions of the lower third of the esophagus were found in 14 (18.9 %) patients from group 1, in 6 (16.2 %) from group 2, and in 2 (10.0 %) patients from group 3. Esophageal stricture was detected in 1 (1.4 %) patient from group 1 in the postoperative period during endoscopic examination. Signs of a “second entrance” to the stomach were found in 16 (13.5 %) patients of group 1, in 5 (13.5 %) of group 2, and in 2 (10.0 %) of group 3. Dislocation of the fundoplication cuff was noted in 1 (1.3 %) patient of group 1, resulting in deformation of the esophagogastric junction and pain syndrome. Pylorospasm was found in 8 (8.8 %) patients from group 1, in 3 (2.9 %) from group 2 and in 1 (5.0 %) patient from group 3. During the X-ray examination, recurrent hiatal hernia was detected: in group 1 — in 10 (13.5 %) cases, in group 2 — in 5 (13.5 %), in group 3 — in 2 (10.0 %). When assessing the quality of life of patients after surgical interventions, it was found that in group 1, the average score on the Gastroesophageal Reflux Disease — Health-Related Quality of Life (GERD-HRQL) questionnaire was (11.0 ± 5.5 (3–35) points, in group 2 — (19.0 ± 8.0 (3–35)), in group 3 — (16.0 ± 7.3 (3–35)) points, which was quite high in all groups. The distribution of satisfaction with the condition in group 1 was as follows: satisfied — 34 (45.9 %) patients, partially satisfied — 24 (32.4 %), unsatisfied — 16 (21.6 %). The distribution of satisfaction with the condition in group 2 was as follows: satisfied — 16 (43.2 %) patients, partially satisfied — 14 (37.8 %), unsatisfied — 7 (19.0 %). The distribution of satisfaction with the condition in group 3 was as follows: satisfied — 9 (45.0 %) patients, partially satisfied — 8 (40.0 %), unsatisfied — 3 (15.0 %). In the distant postoperative period, complications (pylorospasm, dysphagia, dyspeptic disorders, reflux esophagitis, esophageal strictures) occurred in 40 (54.1 %) patients of group 1, in 14 (37.8 %) of group 2, and in 6 (30.0 %) of group 3. There were no significant differences in the frequency of postoperative complications between groups (54.1 vs. 37.8 %, p > 0.05, exact F test; 54.1 vs. 30.0 %, p > 0.05, exact F test; 37.8 vs. 30.0 %, p > 0.05, exact F test). Conclusions. 1. The number of patients who are unsatisfied with the results of surgery according to GERD-HRQL questionnaire, was 21.6 % ((11.0 ± 5.5) points) after Nissen fundoplication, 19.0 % ((19.0 ± 8.0) points) after Toupet fundoplication, and 15.0 % ((16.0 ± 7.3) points) after Dor fundoplication. 2. Failures of the known methods of antireflux laparoscopic interventions for hiatal hernia are associated with the destruction of the components of the physiological cardia and occurred in 40 (54.1 %) patients of group 1 (pylorospasm, dysphagia, dyspeptic disorders, reflux esophagitis, esophageal strictures), in 14 (37.8 %) in group 2 and in 6 (30.0 %) in the third group. 3. Nissen fundoplication in the postoperative period was significantly more often accompanied by dysphagia and pylorospasm compared to Toupet and Dor fundoplications (p < 0.05).

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“…A PEH is characterized by a herniation of the gastric fundus and sometimes the entire stomach (with or without additional viscera) through a widened diaphragmatic hiatus. The indications for surgical repair are controversial but must balance the patient's fitness for surgery and respective symptom burden (2)(3)(4)(5)(6). Surgical repair traditionally includes dissection of the hernia sac from the mediastinum, reduction of herniated intra-abdominal organs, posterior repair of the crura (with or without mesh), and a fundoplication to control reflux.…”

Section: Introductionmentioning

confidence: 99%

The value of “diaphragmatic relaxing incision” for the durability of the crural repair in patients with paraesophageal hernia: a double blind randomized clinical trial

Tsoposidis,

Thorell,

Axelsson

et al. 2023

Front. Surg.

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BackgroundSurgical repair of paraesophageal hernias (PEHs) is burdened with high recurrence rates, and hitherto various techniques explored to enforce the traditional crural repair have not been successful. The hiatal reconstruction in PEH is exposed to significant tension, which may be minimized by adding a diaphragmatic relaxing incision to enhance the durability of the crural repair.Patients and methodsAll individuals undergoing elective laparoscopic repair of a large PEH, irrespective of age, were considered eligible. PEHs were classified into types II–IV. The preoperative work-up program included multidetector computed tomography and symptom assessment questionnaires, which will be repeated during the postoperative follow-up. Patients were randomly divided into a control group with crural repair alone and an intervention group with the addition of a left-sided diaphragmatic relaxing incision at the edge of the upper pole of the spleen. The diaphragmatic defect was then covered by a synthetic mesh.ResultsThe primary endpoint of this trial was the rate of anatomical PEH recurrence at 1 year. Secondary endpoints included symptomatic gastroesophageal reflux disease, dysphagia, odynophagia, gas bloat, regurgitation, chest pain, abdominal pain, nausea, vomiting, postprandial pain, cardiovascular and pulmonary symptoms, and patient satisfaction in the immediate postoperative course (3 months) and at 1 year. Postoperative complications, morbidity, and disease burden were recorded for each patient. This was a double-blind study, meaning that the operation report was filed in a locked archive to keep the patient, staff, and clinical assessors blinded to the study group allocation. Blinding must not be broken during the follow-up unless required by any emergencies in the clinical management of the patient. Likewise, the patients must not be informed about the details of the operation.Trial RegistrationClinicalTrials.gov, identification number NCT04179578.

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Is fundoplication necessary after paraesophageal hernia repair? A meta-analysis and systematic review

Cited by 10 publications

References 35 publications

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

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

Causes of failures of known methods of antireflux laparoscopic interventions for hiatal hernias

The value of “diaphragmatic relaxing incision” for the durability of the crural repair in patients with paraesophageal hernia: a double blind randomized clinical trial

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