Laparoscopic mesh cruroplasty for large paraesophageal hernias

Champion, J. K.; Rock, D.

doi:10.1007/s00464-002-8817-7

Cited by 115 publications

(67 citation statements)

References 11 publications

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“…16,24 We and others advocate the use of mesh reinforcement of hiatal hernia repair in order to decrease the hernia recurrence. 13,17,[36][37][38] The efficacy of PTFE reinforcement in hiatal herniorraphy has been demonstrated in a randomized trial. 13 Our current indication for mesh utilization is a hiatal defect greater than 5 cm.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Frantzides

Madan

Carlson

et al. 2009

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Objective: The aim of this study was to evaluate the mechanisms of failure after laparoscopic fundoplication and the results of revision laparoscopic fundoplication. Background: Laparoscopic Nissen fundoplication has become the most commonly performed antireflux procedure for the treatment of gastroesophageal reflux disease, with success rates from 90 to 95%. Persistent or new symptoms often warrant endoscopic and radiographic studies to find the cause of surgical failure. In experienced hands, reoperative antireflux surgery can be done laparoscopically. We performed a retrospective analysis of all laparoscopic revision of failed fundoplications done by the principle author and the respective fellow within the laparoscopic fellowship from 1992 to 2006. Methods: A review was performed on patients who underwent laparoscopic revision of a failed primary laparoscopic fundoplication. Results: Laparoscopic revision of failed fundoplication was performed on 68 patients between 1992 and 2006. The success rate of the laparoscopic redo Nissen fundoplication was 86%. Symptoms prior to the revision procedure included heartburn (69%), dysphagia (8.8%), or both (11.7%). Preoperative evaluation revealed esophagitis in 41%, hiatal hernia with esophagitis in 36%, hiatal hernia without esophagitis in 7.3%, stenosis in 11.74%, and dysmotility in 2.4%. The main laparoscopic revisions included fundoplication alone (41%) or fundoplication with hiatal hernia repair (50%). Four gastric perforations occurred; these were repaired primarily without further incident. An open conversion was performed in 1 patient. Length of stay was 2.5 Ϯ 1.0 days. Mean follow-up was 22 months (range, 6-42), during which failure of the redo procedure was noted in 9 patients (13.23%). Conclusion: Laparoscopic redo antireflux surgery, performed in a laparoscopic fellowship program, produces excellent results that approach the success rates of primary operations. 135

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Frantzides

Madan

Carlson

et al. 2009

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Nevertheless, other studies have already demonstrated that the use of mesh lowers the rates of recurrence, it is the possibility of complications what we have do pay attention to 1,4,7,8,9,12 . In our series with a long follow-up period, we found no complications related to the use of a mesh, even in those patients with recurrence.…”

Section: Frantzides and Carlsonmentioning

confidence: 95%

“…One topic, however, has gained increasing focus: the use of prosthetic reinforcement of the crural repair 1,3,4,7,8,9,15,20 . Several types of series, prospective non-randomized studies and prospective randomized studies were published or are underway, trying to answer: 1) does it decrease recurrence?…”

Section: Introductionmentioning

confidence: 99%

Tela de polipropileno no reparo laparoscópico de grandes hérnias hiatais: aspectos técnicos

Brandalise¹,

Aranha²,

Brandalise³

2012

ABCD, arq. bras. cir. dig.

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-Background -The minimally invasive surgery has gained rapidly important role in the treatment of gastroesophageal reflux disease. However, the best method to treat large paraesophageal hernias (type III and IV) is still under discussion. The use of prosthetics for enhancing the crural repair has been proposed by several authors in order to reduce the high relapse rates found in these patients. Aim -To demonstrate the technique and surgical results in using an idealized polypropylene mesh for the strengthening of the cruroraphy in large hiatal hernias. Methods -Was applied the polypropylene mesh to reinforce the hiatal closure in large hernias -types II to IV in Hill's classification -with a primary or recurrent hiatal defect greater than 5 cm, in a series of 70 patients. The prosthesis was done cutting a polypropylene mesh in a U-shape, adapted to the dimensions found in the intraoperative field and coating the inner edge (which will have direct contact with the esophagus) with a silicon catheter. This was achieved by removing a small longitudinal segment of the catheter and then inserting the edge of the cut mesh, fixing with running nylon 5-0 suture. Results -From 1999 to 2012, this technique was used in 70 patients. There were 52 females and 18 males, aged 32-83 years (mean 63 years). In 48 (68.6%) patients, paraesophageal hernia was primary and in 22 (31.4%), it was relapse after antireflux surgery. The only case of death in this series (1.4%) occurred on 22nd postoperative day in one patient (74 y) that had a laceration of the sutures on the fundoplication, causing gastropleural fistula and death. There was no relationship with the use of the prosthesis.A follow-up of six months or more was achieved in 60 patients (85.7%), ranging from six to 146 months (mean 49 months). All patients have at least one follow-up endoscopy or esophageal contrast examination, and a clinical interview. In this follow-up period, no cases of complications related to the prosthesis (stenosis or erosion) were observed. Conclusion-The use of this model of polypropylene mesh is safe if the technical aspects of its placement are followed carefully. ABCDDV/874RESUMO -Racional: A cirurgia minimamente invasiva ganhou rapidamente papel fundamental no tratamento da doença do refluxo gastroesofágico. Entretanto, o melhor método para as grandes hérnias paraesofágicas (tipos III e IV) ainda está em discussão. O uso de próteses para reforço da hiatoplastia tem sido proposto por diversos autores, no intuito de diminuir as altas taxas de recidivas encontradas nesses pacientes. Riscos de estenose e erosão da prótese são as complicações mais preocupantes quando se pensa em aplicar uma prótese no hiato esofágico. Objetivo -Demonstrar a técnica cirúrgica e resultados do uso de um modelo de tela idealizado no serviço dos autores para reforçar a hiatoplastia em grandes hérnias de hiato. Métodos -Uma prótese de polipropileno foi aplicada para reforço da hiatoplastia em pacientes com grandes hérnias de hiato (Tipos II a IV de Hill). A prótese ...

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“…Others, however, use mesh in patients with intrathoracic gastric location and recurrences [18,19]. Many surgeons approximate cruses with sutures and lay mesh on cruses [17,20]. They advocate that by doing so mesh would be in less contact with esophagus.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results

Kafadar¹,

Yalaza²,

Türkan³

et al. 2016

CIM

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Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results AbstractPurpose: In this study we report early-term results of laparoscopic Nissen fundoplication with mesh hiatoplasty that we perform to treat gastroesophageal reflux disease. Methods:We retrospectively reviewed the medical records of 68 patients who underwent laparoscopic Nissen fundoplication with mesh hiatoplasty at our clinic. Thirty-six (53%) patients were male and 32 (47%) were female. The mean age of the study population was 46.1 (25-72) years. All patients underwent endoscopy, esophagus pH metry and manometry before the operation. All operations were performed under general anesthesia using five ports. In addition to Nissen fundoplication, all patients also underwent polypropylene mesh placement.Results: Preoperatively, all patients reported a burning sensation in the chest and regurgitation of the stomach contents up into the mouth. The mean time from symptom onset to operation was 28 (6-84) months. All patients were diagnosed with esophagitis in the preoperative endoscopic examination. The mean operative time was 80 (40-125) minutes, the median duration of hospital stay was 1.2 (1-4) days and the median follow-up time was 12 (2-30) months. Functional outcome was excellent in 65% of patients, good in 24.5%, moderately good in 7% and poor in 3.5%. Conclusion:Fundoplication with mesh hiatoplasty is a surgical procedure performed for the traetment of gastroesophageal reflux disease and hiatal hernia. Surgery can be safely carried out with low morbidity and mortality rates and constitutes an alternative to long-term drug therapy. We believe that this operation is beneficial since it reduces the rate of recurrences to a significant degree.SUPPLEMENT

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Laparoscopic mesh cruroplasty for large paraesophageal hernias

Abstract: Early results suggest that prosthetic mesh cruroplasty may be effective in reducing recurrence after laparoscopic repair of large paraesophageal hernias, but long-term follow-up is required in all patients to determine the true incidence of anatomic recurrence and prosthetic erosion.

Cited by 115 publications

References 11 publications

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Tela de polipropileno no reparo laparoscópico de grandes hérnias hiatais: aspectos técnicos

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results

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