Laparoscopic versus Open Repair of Paraesophageal Hernia: The Second Decade

Zehetner, Jörg; DeMeester, Steven R.; Ayazi, Shahin; Kilday, Patrick; Augustin, Florian; Hagen, Jeffrey A.; Lipham, John C.; Sohn, Helen J.; DeMeester, Tom R.

doi:10.1016/j.jamcollsurg.2011.01.060

Cited by 134 publications

(66 citation statements)

References 30 publications

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“…11,12 There are, however, limited data on the durability of improvement and the prevention of interval hiatus hernia complications. 8,13 The effect of recurrence on QoL has not been extensively investigated but recent studies suggest recurrence does not reduce symptomatic outcome. 5,14 The aim of our study was to assess the objective recurrence, QoL and oesophagitis over a long postoperative term in patients undergoing primary repair of GHH.…”

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confidence: 99%

Durability of giant hiatus hernia repair in 455 patients over 20 years

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Furtado

Hayward

et al. 2015

annals

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INTRODUCTION The surgical management of symptomatic giant hiatus hernia (GHH) aims to improve quality of life (QoL) and reduce the risk of life threatening complications. Previous reports are predominantly those with small sample sizes and short follow-up periods. The present study sought to assess a large cohort of patients for recurrence and QoL over a longer time period. METHODS This was a follow-up study of a prospectively collected database of 455 consecutive patients. Primary repair of GHH was evaluated by endoscopy/barium meal for recurrence and a standardised symptom questionnaire for QoL. Recurrence was assessed for size, elapsed time, oesophagitis and symptoms. RESULTS Objective and subjective review was achieved in 91.9% and 68.6% of patients. The median age was 69 years (range: 15-93 years) and 64% were female. Laparoscopic repair was completed in 95% (mesh in 6% and Collis gastroplasty in 7%). The 30-day mortality rate was 0.9%. The proportion of patients alive at five and ten years were 90% and 75% respectively. Postoperative QoL scores improved from a mean of 95 to 111 (p<0.01) and were stable over time (112 at 10 years).The overall recurrence rate was 35.6% (149/418) at 42 months; this was 11.5% (48/418) for hernias >2cm and 24.2% (101/418) for <2cm. The rate of new recurrence at 0-1 years was 13.7% (>2cm = 3.4%, <2cm = 10.3%), at 1-5 years it was 30.8% (>2cm = 9.5%, <2cm = 21.3%), at 5-10 years it was 40.1% (>2cm = 13.8%, <2cm = 26.3%) and at over 10 years it was 50.0% (>2cm = 25.0%, <2cm = 25.0%). Recurrence was associated with oesophagitis but not decreased QoL. Revision surgery was required in 4.8% of cases (14.8% with recurrence). There were no interval major GHH complications. CONCLUSIONS Surgery has provided sustained QoL improvements irrespective of recurrence. Recurrence occurred progressively over ten years and may predispose to oesophagitis.

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confidence: 99%

Durability of giant hiatus hernia repair in 455 patients over 20 years

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Furtado

Hayward

et al. 2015

annals

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“…Despite early reports of higher recurrence rates with the laparoscopic approach [3], recent reports demonstrate benefits of laparoscopic HHR, including low morbidity, low mortality, and shorter hospitalization compared with the open approach [15,16].…”

Section: Discussionmentioning

confidence: 94%

Use of mesh for hiatal hernia repair: a survey of SAGES members

et al. 2012

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“…Few previous studies have specifically addressed the outcome in patients with an asymptomatic recurrent hiatus hernia, and most of these studies have focused on general outcomes following surgery for large hiatus hernia 7,24,25,26 , rather than the specific outcome in patients with asymptomatic recurrences. These reports do, however, suggest that most asymptomatic recurrences might not be clinically relevant, as the initial size of the recurrent hernia is generally small, most don't increase in size over time, few are symptomatic, and recurrences seem unlikely to progress to serious complications.…”

Section: Discussionmentioning

confidence: 99%