Laparoscopic Repair of Paraesophageal Hiatal Hernias

Gantert, Walter; Patti, Marco G.; Arcerito, Massimo; Feo, Carlo V.; Stewart, Lygia; DePinto, Mario; Bhoyrul, Sunil; Rangel, Shawn J.; Tyrrell, Dana; Fujino, Yukio; Mulvihill, Sean J.; Way, Lawrence W.

doi:10.1016/s1072-7515(98)00061-1

Cited by 114 publications

(66 citation statements)

References 17 publications

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Section: Discussionmentioning

confidence: 99%

“…19,21,25,28,30,37,42,48,50,56 The capability to perform these repairs laparoscopically with less pain and a more rapid recovery has provided further impetus to those favoring an aggressive surgical approach. 19,28 However, several prominent surgeons have favored a more conservative approach. 3,4,29,38,47 Furthermore, there is growing appreciation that laparoscopic repair of large type III hiatal hernias can be a difficult operation that is associated with a high rate of hernia recurrence as well as other complications, such as vagal nerve injury.…”

Section: Discussionmentioning

confidence: 99%

“…3,24,28,48,49 In these studies the authors reported the exact interval for which the hernia had been known to be present before the surgical repair. The highest rate was 7/100 patients per year, reported by Hallisey et al 48 (approximately 58 patient-years follow-up).…”

Section: Watchful Waiting: Development Of Acute Symptoms Requiring Emmentioning

confidence: 99%

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Paraesophageal Hernias: Operation or Observation?

Stylopoulos¹,

Gazelle²,

Rattner³

2002

Annals of Surgery

354

202

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ObjectiveTo examine the hypothesis that elective laparoscopic repair should be routinely performed on patients with asymptomatic or minimally symptomatic paraesophageal hernias. Summary Background DataThe management of asymptomatic paraesophageal hernias is a controversial issue. Most surgeons believe that all paraesophageal hernias should be corrected electively on diagnosis, irrespective of symptoms, to prevent the development of complications and avoid the risk of emergency surgery. MethodsA Markov Monte Carlo decision analytic model was developed to track a hypothetical cohort of patients with asymptomatic or minimally symptomatic paraesophageal hernia and reflect the possible clinical outcomes associated with two treatment strategies: elective laparoscopic paraesophageal hernia repair (ELHR) or watchful waiting (WW). The input variables for ELHR were estimated from a pooled analysis of 20 published studies, while those for WW and emergency surgery were derived from the 1997 HCUP-NIS database and surgical literature published from 1964 to 2000. Outcomes for the two strategies were expressed in quality-adjusted lifeyears (QALYs). ResultsAnalysis of the HCUP-NIS database showed that published studies overestimate the mortality of emergency surgery (17% vs. 5.4%). The mortality rate of ELHR was 1.4%. The annual probability of developing acute symptoms requiring emergency surgery with the WW strategy was 1.1%. For patients 65 years of age, ELHR resulted in reduction of 0.13 QALYs (10.78 vs. 10.65) compared with WW. The model predicted that WW was the optimal treatment strategy in 83% of patients and ELHR in the remaining 17%. The model was sensitive only to alterations of the mortality rates of ELHR and emergency surgery. ConclusionsIf ELHR is routinely recommended, it would be more beneficial than WW in fewer than one of five patients. WW is a reasonable alternative for the initial management of patients with asymptomatic or minimally symptomatic paraesophageal hernias, and even if an emergency operation is required, the burden of the procedure is not as severe as was thought in the past.The need for surgical correction of asymptomatic paraesophageal hernias is controversial. Many surgeons, citing the influential studies of Belsey 1 and Hill, 2 advocate elective repair of all paraesophageal hernias irrespective of symptoms. The rationale for this approach is prophylactic; that is, prevention of life-threatening complications such as obstruction and strangulation and avoidance of the significant morbidity and mortality of an emergency operation. The perception that laparoscopic techniques offer a less morbid approach to surgical correction of paraesophageal hernias is cited as an additional reason to support the elective repair of paraesophageal hernias. However, beliefs held by the surgical community about the natural history of paraesophageal hernias and the morbidity and mortality of both elective and emergency operations are based on relatively small patient series and anecdotal case reports. Several recent ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Paraesophageal Hernias: Operation or Observation?

Stylopoulos¹,

Gazelle²,

Rattner³

2002

Annals of Surgery

354

202

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 99%

“…Traditionally, repair of these hernias was performed using an open approach either via a laparotomy or thoracotomy; however, laparoscopic repair has been shown to have improved perioperative outcomes and has thus become the preferred approach [1][2][3][4][5]. The laparoscopic approach provides superior visualization of the surgical field compared to the open technique but it is technically challenging and good outcomes are hinged on good surgical technique and the surgeon's experience [2,6]. Morbidity and mortality rates associated with laparoscopic repair of paraesophageal hernias are relatively low, with previous studies reporting morbidity rates between 4 and 10% and a mortality rate from 0 to 1.7% [3,4,[6][7][8][9][10][11][12][13].…”

mentioning

confidence: 99%

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

et al. 2017

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A Prospective, Randomized Trial of Laparoscopic Polytetrafluoroethylene (PTFE) Patch Repair vs Simple Cruroplasty for Large Hiatal Hernia

et al. 2002

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Large hiatal hernias are prone to disruption, resulting in reherniation, when repaired with simple cruroplasty. The use of mesh may decrease the rate of reherniation in the laparoscopic repair of large hiatal hernias. Design: Prospective, randomized controlled trial. Setting: University-affiliated private hospital. Patients: Seventy-two individuals undergoing laparoscopic Nissen fundoplication with a hernia defect greater or equal to 8 cm in diameter. Intervention: Nissen fundoplication with posterior cruroplasty (n = 36) vs Nissen fundoplication with posterior cruroplasty and onlay of polytetrafluoroethylene (PTFE) mesh (n = 36). Main Outcome Measures: Recurrences, complications, hospital stay, operative time, and cost. Results: Patients in both groups had similar hospital stays, but the PTFE group had a longer operative time. The cost of the repair was $960±$70 more in the group with the prosthesis. Complications were minor and similar in both groups. There were 8 hernia recurrences (22%) in the primary repair group and none in the PTFE group (PϽ.006). Conclusion: The use of prosthetic reinforcement of cruroplasty in large hiatal hernias may prevent hernia recurrences.

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Laparoscopic Repair of Paraesophageal Hiatal Hernias

Cited by 114 publications

References 17 publications

Paraesophageal Hernias: Operation or Observation?

Paraesophageal Hernias: Operation or Observation?

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

A Prospective, Randomized Trial of Laparoscopic Polytetrafluoroethylene (PTFE) Patch Repair vs Simple Cruroplasty for Large Hiatal Hernia

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