Laparoscopic hiatal hernia repair

Müller‐Stich, Beat P.; Holzinger, F.; Kapp, Tobias G.; Klaiber, C

doi:10.1007/s00464-004-2272-6

Cited by 71 publications

(20 citation statements)

References 21 publications

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“…(3, 5, 15, 17–21, 23, 24) Odds of hiatal hernia recurrence were 49% less after mesh cruroplasty, relative to the baseline group of suture cruroplasty (Figure 2. OR 0.51, 95% CI 0.30–0.87; p=0.014).…”

Section: Resultsmentioning

confidence: 97%

“…(5, 15, 17, 19, 21–23) Two studies reported that significantly more patients who received mesh complained of dysphagia in early follow-up compared to patients with suture repair. (16, 23) Stable dysphagia in the overall group was reported by Braghetto.…”

Section: Resultsmentioning

confidence: 99%

“…(16, 23) Stable dysphagia in the overall group was reported by Braghetto. (15)Six studies assessed pre- and post-operative symptoms by cruroplasty types,(5, 16, 17, 19, 21, 23) including varying combinations of heartburn, regurgitation, chest pain, dysphagia, abdominal pain, bloating, nausea, vomiting, early satiety, dyspnea, arrhythmias, anemia, and hoarseness. Eight studies performed symptom assessment based on presence/absence, severity, and/or frequency without validated symptom measures.…”

Section: Resultsmentioning

confidence: 99%

“…(Tables 3 and 4) Only 4 of 13 studies reported time to symptom assessment stratified by repair type,(16, 17, 19, 21) while the remaining provided a range, median, mean, or did not report. Of those that reported this metric, median time to symptom assessment varied greatly (6.5 months to 151 months).…”

Section: Resultsmentioning

confidence: 99%

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A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair

Tam

Winger

Nason

2016

The American Journal of Surgery

143

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Structured Abstract Background Equipoise exists regarding whether mesh cruroplasty during laparoscopic large hiatal hernia repair improves symptomatic outcomes compared to suture repair. Data Source Systematic literature review (MEDLINE and EMBASE) identified 13 studies (1194 patients; 521 suture and 673 mesh) comparing mesh versus suture cruroplasty during laparoscopic repair of large hiatal hernia. We abstracted data regarding symptom assessment, objective recurrence, and reoperation and performed meta-analysis. Conclusions The majority of studies reported significant symptom improvement. Data were insufficient to evaluate symptomatic versus asymptomatic recurrence. Time to evaluation was skewed toward longer follow-up after suture cruroplasty. Odds of recurrence (OR 0.51, 95% CI 0.30–0.87; overall p=0.014) but not need for reoperation (OR 0.42, 95% CI 0.13–1.37; overall p=0.149) were less after mesh cruroplasty. Quality of evidence supporting routine use of mesh cruroplasty is low. Mesh should be used at surgeon discretion until additional studies evaluating symptomatic outcomes, quality of life and long-term recurrence are available.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair

Tam

Winger

Nason

2016

The American Journal of Surgery

143

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“…Although studies have demonstrated a decrease in the PEH recurrence rate with mesh reinforcement [17,18], this technique remains controversial [15,19,20]. The use of synthetic mesh can lead to dysphagia or odyngophagia in up to 21.7% of patients, likely due to esophageal stenosis and periesophageal mesh-induced fibrosis [5,12,21,22]. In addition, Gouvas et al reported significantly more cardiac and respiratory symptoms and a delayed esophageal transit time when comparing prosthetic reinforcement to simple crural repair [23].…”

Section: Discussionmentioning

confidence: 99%

New Surgical Approach for Giant Paraesophageal Hernia Repair: Closure of the Esophageal Hiatus Anteriorly Using the Left Triangular Ligament

et al. 2015

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Background: Obtaining a tension-free repair for giant paraesophageal hernias (PEH) is often challenging. Many different techniques have been proposed, including laparoscopic posterior hiatoplasty with the use of prosthetic or biologic mesh as well as the use of autologous teres or falciform ligament flaps. In this report, we describe the use of the left triangular ligament as an onlay autologous vascularized flap to bridge the anterior residual defect after posterior cruroplasty. Methods: A novel technique of paraesophageal hiatal hernia repair is described. Posterior hiatoplasty is performed, including the approximation of the diaphragmatic crural fibers to the extent possible. The left triangular ligament is then mobilized and sutured to the right and left crural fibers lining the esophageal hiatus to seal the anterior residual diaphragmatic defect. Results: This technique has been performed in 4 patients with a mean age of 71 years and a 3:1 female to male ratio. The average hiatal defect size was 5.5 cm and the average length of operation was 122 min. There was no evidence of radiologic or clinical recurrence on follow-up. Conclusion: The use of the left triangular ligament flap is feasible and may be a valuable tool for closure of an anterior diaphragmatic defect in giant PEHs. Additional studies to validate its long-term function are needed.

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Synthetic Reinforcement of Diaphragm Closure for Large Hiatal Hernia Repair

Nason

2014

Difficult Decisions in Surgery: An Evidence-Based Approach

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Laparoscopic hiatal hernia repair

Abstract: Although challenging, LRPH is a successful procedure. The high recurrence rate reported in the literature can be reduced by additional mesh reinforcement.

Cited by 71 publications

References 21 publications

A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair

A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair

New Surgical Approach for Giant Paraesophageal Hernia Repair: Closure of the Esophageal Hiatus Anteriorly Using the Left Triangular Ligament

Synthetic Reinforcement of Diaphragm Closure for Large Hiatal Hernia Repair

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