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

Kao, Angela M.; Otero, Javier; Schlosser, Kathryn A.; Marx, Julia; Prasad, Tanushree; Colavita, Paul D.; Heniford, B. Todd

doi:10.1177/000313481808400727

Cited by 22 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Approximately 2% (9/536) of the patients underwent surgery for HH recurrence and postoperative dysphagia strictly, excluding EBD for postoperative dysphagia; this number was slightly lower than the 3%–7% reported in Western countries 26‐28 . Kao et al 29 showed that laparoscopic redo surgery can be safely performed, although the operation time is long and the conversion rate is high. In addition, the reoperation was more durable than the first operation and improved the symptoms in most patients.…”

Section: Discussionmentioning

confidence: 91%

Treatment strategy for laparoscopic hiatal hernia repair

Yano

Tsuboi

Omura

et al. 2021

Asian J Endoscop Surgery

View full text Add to dashboard Cite

Introduction According to the anatomy‐function‐pathology classification, the recurrence rates of A2 and A3 hiatal hernia (HH) after laparoscopic fundoplication are higher than the rate of A1 HH. Therefore, we introduced mesh reinforcement for A2 and A3 cases. In addition, gastropexy was added to A3 cases. We present the strategy for HH repair. Methods In all, 537 patients (mean age 55.4 ± 16.7 years, 219 women) who underwent primary laparoscopic fundoplication for HH from January 1995 to October 2019 were included. They were divided into three groups by A factor (A1:A2:A3 = 296:156:85). Their clinical data were collected in a prospective fashion and retrospectively reviewed. Results The median age (years) of the patients in each group was A1:A2:A3 = 46:63:74 years, and age was directly proportional to the size of HH (P < 0.0001). The proportion of females was significantly higher in A3 than in other classes (P < 0.0001). Preoperative reflux esophagitis was severe in A2 (P < 0.0001) and operation time (min) was directly proportional to HH size (A1:A2:A3 = 135:167:193, P < 0.0001). The recurrence rate of conventional laparoscopic fundoplication was 15% (46/304), and it was higher for A2 and A3 than for A1 (P = 0.027). However, with reinforcement of the hiatus using a mesh and gastropexy, the recurrence rates decreased. Conclusion Combining mesh reinforcement and gastropexy may reduce the recurrence rate of para‐ and mixed‐type HH.

show abstract

Section: Discussionmentioning

confidence: 91%

Treatment strategy for laparoscopic hiatal hernia repair

Yano

Tsuboi

Omura

et al. 2021

Asian J Endoscop Surgery

View full text Add to dashboard Cite

show abstract

“…Recurrence was determined by symptoms, 13,17,21,23,24,28,30 symptoms and use of medical therapy, 14,34,38 symptoms and upper gastrointestinal series, 15,18,27,37 symptoms, upper gastrointestinal series and endoscopy, 32 or symptoms and pH monitoring 19,25,29 . Some studies did not report how recurrence was defined 31,33,36,40,41 …”

Section: Methodsmentioning

confidence: 99%

“…A laparoscopic redo fundoplication (LRF) is a technically demanding operation due to the presence of adhesions and altered anatomy. Although several studies have demonstrated the safety and efficacy of laparoscopic reoperative antireflux surgery, 13–42 large series or randomized trials to support this evidence are still lacking. Therefore, the aim of this systematic review and meta-analysis was to summarize the current available studies and determine the surgical outcomes of LRF.…”

mentioning

confidence: 99%

Outcomes of Laparoscopic Redo Fundoplication in Patients With Failed Antireflux Surgery

et al. 2020

View full text Add to dashboard Cite

The aim of this meta-analysis was to summarize the current available evidence regarding the surgical outcomes of laparoscopic redo fundoplication (LRF). Summary of Background Data: Although antireflux surgery is highly effective, a minority of patients will require a LRF due to recurrent symptoms, mechanical failure, or intolerable side-effects of the primary repair. Methods: A systematic electronic search on LRF was conducted in the Medline database and Cochrane Central Register of Controlled Trials. Conversion and postoperative morbidity were used as primary endpoints to determine feasibility and safety. Symptom improvement, QoL improvement, and recurrence rates were used as secondary endpoints to assess efficacy. Heterogeneity across studies was tested with the Chi-square and the proportion of total variation attributable to heterogeneity was estimated by the inconsistency (I 2 ) statistic. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) across all studies. Results: A total of 30 studies and 2,095 LRF were included. The mean age at reoperation was 53.3 years. The weighted pooled proportion of conversion was 6.02% (95% CI, 4.16%-8.91%) and the meta-analytic prevalence of major morbidity was 4.98% (95% CI, 3.31%-6.95%). The mean follow-up period was 25 (6-58) months. The weighted pooled proportion of symptom and QoL improvement was 78.50% (95% CI, 74.71%-82.03%) and 80.65% (95% CI, 75.80%-85.08%), respectively. The meta-analytic prevalence estimate of recurrence across the studies was 10.71% (95% CI, 7.74%-14.10%). Conclusions: LRF is a feasible and safe procedure that provides symptom relief and improved QoL to the vast majority of patients. Although heterogeneously assessed, recurrence rates seem to be low. LRF should be considered a valuable treatment modality for patients with failed antireflux surgery.

show abstract

“…Re-operative intervention for failed fundoplication can be performed through a minimally invasive approach with good results (14,(17)(18)(19)(20). In a recent study performed at the University of Pittsburgh, re-operative results for failed fundoplication were analyzed.…”

Section: Commentsmentioning

confidence: 99%

Laparoscopic approaches to failed fundoplication for reflux

Tamesis¹,

Witek²,

Luketich³

et al. 2020

Shanghai Chest

View full text Add to dashboard Cite

With laparoscopic primary fundoplication now a well-established treatment for gastroesophageal reflux disease (GERD), there is an increasing number of patients that are being referred for complex reoperative intervention for failed primary fundoplication. The majority of patients presenting with failed primary fundoplication can be managed non-operatively, a subset of patients will benefit from re-operative surgery. Re-operative anti-reflux surgery can usually be performed using minimally invasive techniques with good results. The key principle of re-operative surgery for failed fundoplication is establishing and restoration of normal anatomy. It is also essential to perform complete mediastinal esophageal mobilization to recognize a short esophagus, and to preserve crural integrity. The surgical options for an anti-reflux procedure include redo-fundoplication, and Roux-en-Y near esophagojejunostomy (RNYNEJ). In some instances, esophagectomy may be indicated.

show abstract

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

Cited by 22 publications

References 23 publications

Treatment strategy for laparoscopic hiatal hernia repair

Treatment strategy for laparoscopic hiatal hernia repair

Outcomes of Laparoscopic Redo Fundoplication in Patients With Failed Antireflux Surgery

Laparoscopic approaches to failed fundoplication for reflux

Contact Info

Product

Resources

About