Laparoscopic repair of giant paraesophageal hernia: are there factors associated with anatomic recurrence?

Antiporda, Michael; Veenstra, Benjamin R.; Jackson, Chloe; Kandel, Pujan; Smith, C. Daniel; Bowers, Steven P.

doi:10.1007/s00464-017-5770-z

Cited by 22 publications

(21 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although this is an excellent technique in the short term, the recurrence at 10 years is estimated between 35 to 50% in most centers [6].…”

Section: Discussionmentioning

confidence: 99%

“…One of the contraindications for laparoscopic techniques is a patient in shock by the risk of cardiac arrest secondary to the decreased hearth preload during the pneumoperitoneum insuffl ation. For those reasons we decided not to perform the laparoscopic correction in this specifi c case, and patient evolved with excellent results and a hospital stay shorter than any of the reported, inclusive in some laparoscopic corrections [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Incarcerated Giant Hiatal Hernia conditioning hearth shock: case report

Angel¹

2015

Arch Clin Gastroenterol

View full text Add to dashboard Cite

Between the hiatal hernias, the type IV is the less frequent by the great defect, but this type had a high incidence of incarceration (5%), and a mortality rate up to 27%. Case:A female patient of 80 years-old was referred to our hospital by septic shock and abdominal pain. At physical exam she refers abdominal and thoracic pain, dyspnea and occasional threw up for the last 2 days, with a background of this symptoms the last 5 years, and gastroesophageal refl ux symptoms for 10 years. At admission, she referred epigastric and retrosternal pain, dyspnea, with an 02 of 75%, bowel sounds in left hemithorax, mean arterial pressure of 50mmHg with the use of norepinephrine. Laboratories do not reveal sepsis and CT scan reports a hiatal hernia of 9 cm with left hemithorax occupied by stomach, colon, and spleen. A cardiogenic shock by compression was suspected with this data and a laparotomy was scheduled. CT scan report was confi rmed and the mentioned organs were reduced to abdomen without problems, both diaphragmatic pillars were sutured and a Nissen fundoplication completed. After 6 hours' norepinephrine was suspended and 48 hours after the patient were discharged uneventfully. Conclusion:Giant hiatal hernia must be suspected in patients with chronic abdominal and thoracic pain with refl ux symptoms because the complications associated with this disease could have a mortality near 30% in case of strangulation and a scheduled surgery could be very safe in the correct moment.

show abstract

“…Although this is an excellent technique in the short term, the recurrence at 10 years is estimated between 35 to 50% in most centers [6].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incarcerated Giant Hiatal Hernia conditioning hearth shock: case report

Angel¹

2015

Arch Clin Gastroenterol

View full text Add to dashboard Cite

show abstract

“…5,8,10,27,[35][36][37][38] Representative studies are depicted in Table 2. 10,27,[37][38][39][40][41] One thing that is clear is that GPEH operations, and in particular redo operations, are best done at high-volume centers. Schlottman and colleagues 42 31 Johnson et al, 1998 6 Jobe et al, 1998 32 Lin et al, 2004 33 Whitson et al, 2006 34 Nason et al, 2011 30…”

Section: Assessment Of Long-term Outcomesmentioning

confidence: 99%

“…They noted a "spontaneous centralization" of PEH repairs, which we believe should be encouraged. A second study reviewed 595 patients who underwent laparoscopic PEH repair and found that surgeon volume (high >10 operations annually) was predictive of recurrence 40.…”

mentioning

confidence: 99%

Giant paraesophageal hernia: What do we really know?

Bhargava

Andrade

2020

JTCVS Techniques

View full text Add to dashboard Cite

Feature Editor Note-The management of giant paraesophageal hernias remains challenging. In this invited expert opinion article, Bhargava and Andrade provide an in-depth discussion of the controversies surrounding repair of giant paraesophageal hernias, including management of recurrent hiatal hernias, esophageal-lengthening procedures, and the use of mesh. Based on their own practice, they suggest performing an extensive mediastinal dissection to achieve adequate intra-abdominal esophageal length, gastroplasty when needed for esophageal shortening, and the avoidance of mesh due to the risk of erosion, cost, and lack of clear data supporting its use. Other practices are more controversial, such as placement of a gastrostomy tube for recurrent hernias in the hopes of preventing recurrence, avoidance of a fundoplication in patients with morbid obesity, and usage of a pharyngostomy tube for decompression, which is considered a legacy procedure by most surgeons.Recurrent paraesophageal hernias in particular require a thoughtful approach, including obtaining the operative report from the initial operation when possible, considering the severity of the patient's symptoms, and careful review of objective data from current studies. Patients with multiple previous repairs are unlikely to benefit from a repeat repair, and partial gastrectomy with Roux-en-Y esophagojejunostomy or esophagectomy should be reserved for those with severe symptoms such as the inability to tolerate an oral diet.The authors emphasize the importance of clearly defining what constitutes a giant paraesophageal hernia, the natural history, and an objective assessment of short-and long-term outcomes. While there have been substantial advances, repair of a giant paraesophageal hernia continues to be a challenging procedure, particularly redo repair, and should be performed in experienced, high-volume centers.Giant paraesophageal hernia characterization remains a challenging concept. CENTRAL MESSAGELaparoscopic giant paraesophageal hernia repair remains in evolution. We use extensive mediastinal dissection to achieve intra-abdominal esophageal length, gastroplasty as needed, and avoid mesh.See Commentary on page 373.

show abstract

“…[6][7][8] Despite the use of such techniques, recurrence at six months after PEHR has been reported as high as 34 per cent. 9 As such, controversy exists regarding the optimal combination of surgical techniques.…”

mentioning

confidence: 99%

One More Time: Redo Paraesophageal Hernia Repair Results in Safe, Durable Outcomes Compared with Primary Repairs

Kao

Otero

Schlosser

et al. 2018

The American Surgeon

View full text Add to dashboard Cite

The incidence and causes of failed paraesophageal hernia repairs (PEHR) remain poorly understood. Our study aimed to evaluate long-term clinical outcomes after reoperative fundoplication as compared with initial PEHR. A prospectively maintained institutional hernia-specific database was queried for PEHR between 2008 and 2017. Patients with prior history of PEHR were categorized as “redo” paraesophageal hernia (RPEH). Primary outcomes included postoperative morbidity, mortality, symptom resolution, and hernia recurrence. A total of 402 patients underwent minimally invasive PEHR (Initial PEH = 305, RPEH = 97). Redo PEHR had more prevalent preoperative nausea/vomiting (50.6% vs 34.1%, P < 0.007) and weight loss (24.1% vs 13.5%, P < 0.02). RPEH had had longer mean operative time (256.4 ± 91.2 vs 190.3 ± 59.9 minutes, P < 0.0001) and higher rate of conversion to open (10.3% vs 0.67%, P < 0.0001); however, no difference was noted in postoperative complications, hernia recurrence, or mortality between cohorts. Laparoscopic revision of prior PEHR in symptomatic patients can be safely performed with favorable outcomes compared with initial PEHR. Despite redo procedures seeming to be more technically demanding (as noted by longer operative time and higher conversion rates), outcomes are similar and overall resolution of symptoms is achieved in most patients.

show abstract

Laparoscopic repair of giant paraesophageal hernia: are there factors associated with anatomic recurrence?

Cited by 22 publications

References 32 publications

Incarcerated Giant Hiatal Hernia conditioning hearth shock: case report

Incarcerated Giant Hiatal Hernia conditioning hearth shock: case report

Giant paraesophageal hernia: What do we really know?

One More Time: Redo Paraesophageal Hernia Repair Results in Safe, Durable Outcomes Compared with Primary Repairs

Contact Info

Product

Resources

About