Less is more: cruroplasty alone is sufficient for revisional hiatal hernia surgery

Nguyen, Robert; Dunn, Colin P; Putnam, Luke R.; Won, Paul; Patel, Tanu; Brito, Stephanie; Bildzukewicz, Nikolai A.; Lipham, John C.

doi:10.1007/s00464-020-07897-7

Cited by 7 publications

(5 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may be in part due to the inclusion of patients undergoing MSA in the full revision group, as MSA device placement requires shorter operative times compared to fundoplication [16,17]. However previous data also demonstrated no difference in operative times between cruroplasty alone and redo fundoplication, suggesting that crural dissection and lysis of adhesions are the most difficult components of revisional surgery [12]. There was no difference in the rates of intraoperative complications between groups, but the incidence of intraoperative complications overall was very low making statistical analysis difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Cruroplasty with or without mesh was performed according to the technique described by Nguyen et al [12]. Following hiatal hernia repair, intraoperative endoscopy was performed.…”

Section: Operative Characteristicsmentioning

confidence: 99%

“…Given the significant morbidity associated with redo operations and the theory that most of the reflux in these patients is due to recurrent hiatal hernias, we set out to determine whether or not redoing the fundoplication was necessary or not. In other words, based on evidence highlighting the significant role of the diaphragmatic crura in the GERD barrier following laparoscopic anti-reflux surgery (LARS), cruroplasty alone for management of recurrent hiatal hernias in patients with intact fundoplications may decrease the morbidity associated with these operations while reestablishing an effective GERD barrier [12]. This study aims to expand on prior research to further evaluate outcomes following cruroplasty alone compared to cruroplasty and fundoplication revision for the management of recurrent hiatal hernias.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cruroplasty as a standalone treatment for recurrent hiatal hernia repair

Tran,

Putnam,

Harvey

et al. 2024

Hernia

Self Cite

View full text Add to dashboard Cite

Purpose Following laparoscopic anti-reflux surgery (LARS), recurrence of hiatal hernia is common. Patients with symptomatic recurrence typically undergo revision of the fundoplication or conversion to magnetic sphincter augmentation (MSA) in addition to cruroplasty. However, patients with an intact fundoplication or MSA may only require repeat cruroplasty to repair their recurrent hiatal hernia. The purpose of this study is to compare outcomes following cruroplasty alone compared to full revision (i.e. redo fundoplication or MSA with cruroplasty) for the management of recurrent hiatal hernias. Methods A retrospective review of patients undergoing surgical revision of a symptomatic recurrent hiatal hernia between February 2009 and October 2022 was performed. Preoperative characteristics, intraoperative details, and postoperative outcomes were compared between patients undergoing cruroplasty alone versus full revision. Results A total of 141 patients were included in the analysis. 93 patients underwent full revision, and 48 patients underwent cruroplasty alone. The mean time between initial and revisional surgery was 8 ± 7.7 years. There was no significant difference in operative time or rates of intra-operative or post-operative complication between groups. Patients undergoing cruroplasty alone had a mean Gastroesophageal Reflux Disease Health Related Quality Life (GERD-HRQL) Questionnaire score of 9.6 ± 10.2 compared to a mean score of 8.9 ± 11.2 for full revision patients (p = 0.829). Recurrence rates following revision was 10.4% for cruroplasty alone patients and 11.8% in full revision patients (p > 0.999). Conclusion In patients with intact fundoplication or MSA, cruroplasty alone results in similar post-operative outcomes compared to full revision for recurrent hiatal hernia.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Cruroplasty with or without mesh was performed according to the technique described by Nguyen et al [12]. Following hiatal hernia repair, intraoperative endoscopy was performed.…”

Section: Operative Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cruroplasty as a standalone treatment for recurrent hiatal hernia repair

Tran,

Putnam,

Harvey

et al. 2024

Hernia

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition, indirect evidence supporting the pivotal role of crural repair emerged from studies showing that a previous fundoplication can be left intact without adversely affecting the outcomes of patients undergoing revisional HH surgery. 10 All the above findings suggest that full crural repair substantially contributes to LES augmentation and to the success of antireflux surgery.…”

Section: History and Revisitation Of Crural Repair For Gerdmentioning

confidence: 91%

The Controversial Role of Concurrent Crural Plasty in Bariatric Surgery: Where Is the Evidence?

Bonavina

Asti

Bernardi

et al. 2021

Foregut: The Journal of the American Foregut Society

View full text Add to dashboard Cite

Gastroesophageal reflux disease is diagnosed at an alarming rate after laparoscopic sleeve gastrectomy. Revisional surgery with conversion to Roux-en-Y gastric bypass does not guarantee reflux control and is associated with morbidity. There is a need to optimize the objective foregut patient pathway prior to bariatric surgery and to perform concurrent hiatal repair in individuals with a defective esophago-gastric junction and abnormal esophageal acid exposure. The role of adjunctive surgical procedures (hiatal reinforcement, fundoplication, magnetic sphincter augmentation) is still controversial due to lack of follow-up and standardized reporting, and current recommendations are based on expert opinion or case series.

show abstract

“…15 In select cases where it appears that the fundoplication was properly constructed and that an intact and functional fundoplication simply herniated into the mediastinum, it may be acceptable to leave a previous fundoplication intact. 16 In the opinion of the senior author, this requires a clear history of excellent functional outcomes prior to failure and a fundoplication with the correct geometric appearance and location relative to the esophagogastric junction as assessed by intraoperative endoscopy at the time of revision. When in doubt, it is better to take a questionable fundoplication down and reconstruct methodically rather than take a chance that fixing a hiatal hernia only will not be enough to address a patient's recurrent symptoms.…”

Section: Technical Aspects Of Revisional Fundoplicationmentioning

confidence: 99%

Outcomes of Revisional Fundoplication Surgery

Gould

2023

Foregut: The Journal of the American Foregut Society

View full text Add to dashboard Cite

Outcomes following revisional fundoplication procedures are very good in the hands of experienced surgeons. Minimally invasive approaches with laparoscopy or robotic surgical systems are feasible with low conversion rates. Proper patient selection and evaluation are essential. Morbidity, length of stay, and operative time all tend to increase in revisions. This is especially true as the number of prior fundoplication attempts increases. GERD outcomes, quality of life, and patient satisfaction are excellent. Outcomes appear to be durable with recurrence rates slightly higher than recurrence rates following primary fundoplication.

show abstract

Less is more: cruroplasty alone is sufficient for revisional hiatal hernia surgery

Cited by 7 publications

References 26 publications

Cruroplasty as a standalone treatment for recurrent hiatal hernia repair

Cruroplasty as a standalone treatment for recurrent hiatal hernia repair

The Controversial Role of Concurrent Crural Plasty in Bariatric Surgery: Where Is the Evidence?

Outcomes of Revisional Fundoplication Surgery

Contact Info

Product

Resources

About