Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate1

Hashemi, Majid; Peters, Jeffrey H.; DeMeester, Tom R.; Huprich, James E.; Quek, Marcus; Hagen, Jeffrey A.; Crookes, Peter F.; Theisen, Jörg; DeMeester, Steven R.; Sillin, Lelan F.; Bremner, Cedric G.

doi:10.1016/s1072-7515(00)00260-x

Cited by 480 publications

(360 citation statements)

References 25 publications

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“…Previous reports from randomized trials 13,14,15,23 , and other studies 4,6,10 have all focussed on clinical and objective outcome parameters. However, quality of life is an alternative patient reported outcome, which reflects the general well-being and the functional status of patients.…”

Section: Discussionmentioning

confidence: 99%

Quality of Life Following Repair of Large Hiatal Hernia is Improved but not Influenced by Use of Mesh: Results From a Randomized Controlled Trial

et al. 2015

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Introduction Laparoscopic surgery is the treatment of choice for repair of large hiatus hernia, but can be followed by recurrence. Repair with prosthetic mesh has been recommended to prevent recurrence, although complications following mesh repair have generated disagreement about whether or not mesh should be used. The early objective and clinical results of a randomized trial of repair with mesh versus sutures have been reported, and revealed few differences. In the current study, we evaluated quality of life outcomes within this trial at follow-up to 2 years. Methods In a multicenter prospective double-blind randomized trial three methods for repair of large hiatus hernia were compared: sutures versus repair with absorbable mesh (Surgisis) versus non-absorbable (Timesh). Quality of life assessment using the Short-Form 36 (SF-36) questionnaire was undertaken at 3, 6, 12 and 24 months after surgery. SF-36 outcomes (8 individual scales and 2 composite scales) were determined for each group, and compared between groups, and across different follow-up points. Results 126 patients were enrolled-43 sutures, 41 absorbable mesh and 42 non-absorbable mesh. 115 (91.3 %) completed a preoperative questionnaire, and 113 (89.7 %) completed the post-operative questionnaire at 3 months, 116 (92.1 %) at 6 months, 114 (90.5 %) at 12 months, and 91 (72.2 %) at 24 months. The SF-36 Physical and Mental Component Scores (PCS and MCS) improved significantly following surgery, and this improvement was sustained across 24 months follow-up (p \ 0.001 for PCS and MCS at each follow-up point). There were no significant differences between the groups for the component scores or the eight SF-36 subscale scores at each follow-up time. 29 individuals had a recurrence at 6 months follow-up, of which 9 were symptomatic. The PCS were higher in patients with recurrence versus without (p \ 0.01), and in patients with a symptomatic recurrence versus asymptomatic recurrence versus no recurrence (p = 0.001). Conclusion SF-36 measured quality of life improved significantly after repair of large hiatal hernia at up to 2 years follow-up, and there were no differences in outcome for the different repair techniques. The use of mesh versus no mesh in repair of large hiatal hernia did not influence quality of life.

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Section: Discussionmentioning

confidence: 99%

Quality of Life Following Repair of Large Hiatal Hernia is Improved but not Influenced by Use of Mesh: Results From a Randomized Controlled Trial

et al. 2015

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“…Evantrasyonda etkilenen hastaların %70'de ek patolojiler olabileceğinden cerrahi girişim öncesi hastalar bütünüyle değerlendirilmelidir [1]. Ayırıcı tanıda göğüs X-ray filmi ve ultrasonun yanında BT ve manyetik rezonans (MR) görüntülemenin de faydası vardır [5]. Hastalarımızın hepsinde BT çekilmiş ve yapılan incelemelerde başka hastalığa ait bulguya rastlanmamıştır.…”

Section: Discussionunclassified

Clinical Experience with Diaphragmatic Eventrations

Akar¹

2012

Ann Clin Anal Med

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ÖzetAmaç: Yetişkinlerde görülen diyafragma evantrasyonu ve paralizisi, sebebi tam olarak açıklanamayan ve nadir görülen hastalıklardandır. Kliniğimizde 2007-2011 yılları arası diyafragma evantrasyonu ve disfonksiyonları nedeniyle operasyona alınmış 10 hastayı klinik özellikleri ve cerrahi seçenekler yönünden inceledik. Gereç ve Yöntem: Göğüs X-ray filimleri, bilgisayarlı gö-ğüs tomografisi ve floroskopi, hastaların ameliyat öncesi değerlendirilmele-rinde kullanıldı. Bütün hastalara sadece preoperatif dönemde solunum fonksiyon testi yapıldı. Hastalara sol posterolateral torakotomi insizyonu ile yaklaşıldı. Bir hastada politetrafloroetilen greft, üç hastada santral tendon plikasyonu ve altı hastada ise diyafragma yaprakları üst üste kaydırılarak operasyon yapıldı. Bulgular: Hastaların beşi erkek beşi kadındı. Yaş aralığı 13-68 yıl olup ortalama yaş 39,5 yıl idi. Hastalarda travma ve geçirilmiş enfeksiyon bulguları ile kronik hastalık öyküsü yoktu. Hastaların postoperatif çekilen akciğer filimlerinde diyafragmanın en az iki kot aşağıya indirildiği görüldü. Hastaların hastanede kalma süreleri ortalama 8,5 gündü (5-15 gün). Uygulanan cerrahi yöntem farklılıklarına rağmen hastalar arasında hastanede kalış süre-si, semptomların gerileme sürelerinde belirgin farklılık görülmediği gibi nüks-te görülmedi. Sonuç: Her üç cerrahi yöntem farklılığından sonra prognozun iyi seyretmesi, kalıcı problemlerin görülmemesi ve egzersiz kapasitelerinde anlamlı klinik artışın olması diyafragma evantrasyonu ve disfonksiyonlarında operasyon önermemize neden olmuştur. Anahtar KelimelerDiyafragma Yükselmesi; Paralizi; Torakotomi Abstract Aim: Diaphragmatic eventrations and paralysis in adulthood are among the rare conditions with unknown etiology. We evaluated 10 patients who were operated on because of diaphragmatic eventrations and dysfunctions between 2007 and 2010 in terms of clinical features and surgical options. Material and Method: Chest X-ray films, chest computed tomography and fluoroscopy, preoprerative evaluation of patients was used. Respiratory function tests were done for all patients only in preoperative period. Patients were approached with left posterolateral thoracotomy incision. One patient underwent polytetrafluoroethylene grafting, three patients underwent central tendon plication and six patients were operated by overlapping diaphragmatic parts. Results: Five patients were male and five patients were female with mean age of 39,5 years (range 13-68). Patients did not have a history of chronic diseases and findings of trauma or previous infections. Diaphragm was seen to get down at least two ribs on chest x-rays obtained postoperatively. Mean duration of hospital stay was 8,5 days (5-15 days). There was not a significant difference between patients in terms of duration of hospital stay, time to regression of symptoms despite different surgical methods. Discussion: Good prognosis, absence of permanent problems and significant clinical improvement of exercise capacity led us to recommend surgery for diaphragmatic eventrat...

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“…The goal for repair of the hiatus nevertheless should be the creation of a tension-free repair. A high recurrence rate after laparoscopic primary sutured cruroplasty, especially for large hiatus hernia (3,4), is suggestive that suture repair alone does not provide an optimal tension-free repair. Our own experience demonstrated a higher recurrence rate in patients with sutured cruroplasty compared to mesh cruroplasty (14.9% vs 5.8%).…”

Section: Discussionmentioning

confidence: 99%

“…Numerous series have demonstrated the safety and effi cacy of approaching gastrooesophageal refl ux disease (GERD) and hiatus hernia repair by the laparoscopic approach [1,2]. Despite increasing experience with laparoscopic hiatal hernia repair, authors continue to report recurrence rate of up to 43% with sutured cruroplasty [3,4]. This compares laparoscopic hiatal hernia repair poorly to open repair as it is well documented that open hiatal hernia repair with addition of Stamm gastrostomy is associated with very low recurrence rate [5,6].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic management of large hiatus hernia with mesh cruroplasty

Chowbey

Mittal²,

Dey³

et al. 2008

Indian J Surg

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Purpose Laparoscopy has become the standard surgical approach to surgery for gastrooesophageal refl ux disease (GERD) and hiatal hernia repair with excellent long-term results and high patient satisfaction. However several studies have shown that hiatal hernia repair, especially large hiatus are associated with high recurrence rate. Mesh reinforcement has been proposed for repair of large hiatus hernia. The objective of this study was to evaluate the role of mesh cruroplasty in management of large hiatus hernia (> 5 cm).Methods Between February 2002 to December 2007, 73 patients (28 men and 45 women) who underwent laparoscopic hiatal hernia repair with mesh cruroplasty were included in our study. Mesh reinforcement (cruroplasty) was used for repair of large hiatus hernia (>5 cms hernial defect). Mean age was 50.4 years (range 30-72 years). Follow up included barium swallow of patients at 3 months and yearly thereafter.Results Seventy-three patients underwent mesh cruroplasty for large hiatus hernia. We were able to adequately mobilise the oesophagus to achieve an intra-abdominal length of at least 3 cm in all patients. Intraoperative complication rate was 8.21% (6/73), intraoperative complications included pleural tear, bleeding from splenic capsule laceration and short gastric vessels. Postoperative complication rate was 4.1% (3/73), which included complete dyspahgia, atelactasis and pneumonia. Mean duration of hospitalisation was 3.5 days (range 3-9 days). Five patients (5/73) were lost to follow up. Four patients (5.8%) developed recurrence on routine follow up. No mesh related complications were noted on long-term follow up period. Mean follow up period was 3.2 years (range 5 months-6 years). ConclusionOur data supports the use of mesh in hiatal hernia repair, especially in large hiatus hernia as it leads to low recurrence rates. Longer follow up and more randomised controlled trials are needed to establish laparoscopic mesh cruroplasty as standard technique for large hiatal hernia repair.

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Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate1

Cited by 480 publications

References 25 publications

Quality of Life Following Repair of Large Hiatal Hernia is Improved but not Influenced by Use of Mesh: Results From a Randomized Controlled Trial

Quality of Life Following Repair of Large Hiatal Hernia is Improved but not Influenced by Use of Mesh: Results From a Randomized Controlled Trial

Clinical Experience with Diaphragmatic Eventrations

Laparoscopic management of large hiatus hernia with mesh cruroplasty

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