Outcome for Asymptomatic Recurrence Following Laparoscopic Repair of Very Large Hiatus Hernia

Wang, Zhenyu; Bright, Tim; Irvine, Tanya; Thompson, Sarah K.; Devitt, Peter G.; Watson, David I.

doi:10.1007/s11605-015-2807-2

Cited by 17 publications

(12 citation statements)

References 30 publications

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“…Importantly, this is also internally consistent with the line-item analysis showing that the subjects reported fewer issues with medication and effects on daily life. Wang et al 26 showed that subjects with small recurrent hernias were more likely to report heartburn and proton pump inhibitor use than those without recurrences. The convergent drug data presented here suggest that the cohort studied here are less likely to have small recurrent herniations during the time frame reviewed.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Review and Prospective Follow-up of 85 Consecutive Patients Treated With a Novel Hepatic-derived Surgical Mesh for Hiatal Hernia Repair: Outcomes, Surgical Complications, and Revisions

Gillian

Bansal²

2019

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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This study examined outcomes, surgical complications, and revisions in patients treated with laparoscopic Nissen fundoplication for hiatal hernia and substantial gastroesophageal reflux disease. In total, 85 consecutive patients who underwent hernia repair with MIROMESH Biologic Matrix, a novel hepatic-derived surgical mesh served as subjects. Subjects were contacted by phone, consented, and participated in an Institutional Review Board-approved structured phone interview. Responses were acquired from 73 of the 85 patients. The gastroesophageal reflux disease health-related quality of life showed significant improvement postoperatively. Subjects reported high satisfaction with the procedure. The use of proton pump inhibitors was significantly reduced. Three minor complications were reported; these were quickly resolved without further sequelae. There were no mesh-related complications. No subjects reported further surgery. Placement of the surgical mesh, during surgery, to reinforce the hiatal repair was easy and safe. Excellent outcomes and no revisions a mean of 1.3 years after surgery suggest that a durable repair had been achieved.

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Section: Discussionmentioning

confidence: 99%

Retrospective Review and Prospective Follow-up of 85 Consecutive Patients Treated With a Novel Hepatic-derived Surgical Mesh for Hiatal Hernia Repair: Outcomes, Surgical Complications, and Revisions

Gillian

Bansal²

2019

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…If thorough radiological assessment is performed, a recurrent HH has been defined in 15% to 42% of patients (median 22%) [1,13,36,37,41]. Wang, et al reported a prospective study looking at the clinical significance of asymptomatic recurrences and found that 35.7% of patient had a radiological recurrence [47]. Whilst there were significantly higher rates of subjective reflux and PPI usage at longer-term follow-up, 94.6% reported satisfaction with their initial operation and the re-operation rate of only 1.7%.…”

Section: The Risk Of Recurrent Hhmentioning

confidence: 99%

Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

Chan

2017

J Clin Gastroenterol Treat

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The term "giant hiatus hernia" has been variably defined, but most authors refer to at least 30% of the stomach, with or without other abdominal viscera, herniating through the oesophageal hiatus of the diaphragm into the mediastinum. This causes dysfunction of the lower oesophageal sphincter complex and can lead to obstructive symptoms, atypical extra-oesophageal symptoms as well as medically difficult to control reflux. When indicated, operative repair involves complete reduction of the hernia and the associated peritoneal sac, and partial hiatal closure in combination with an anti-reflux procedure. Surgery for giant hiatal hernias is complex, but can be performed with low morbidity and mortality with effective, long-term symptom resolution and improvement in health related quality of life.

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“…The best available evidence suggests that more than half of patients undergoing laparoscopic PEHR will have radiographic hernia recurrence at 5 years after surgery [ 2 ]. Although the likelihood of patients needing revisional surgery for a recurrent hiatal hernia is low, ranging from 0.01 to 7% [ 2 – 10 ], patients with a recurrent hiatal hernia have increased symptoms of heartburn [ 8 , 11 – 13 ], early satiety, gas bloat, difficulty and pain with swallowing [ 3 , 4 ], and worse quality of life [ 14 ] compared to those without a recurrence. A prospective study by Le Page et al evaluating 455 patients over 20 years after PEHR found that recurrences were also associated with increased rates of esophagitis [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing anterior gastropexy to no anterior gastropexy for paraesophageal hernia repair: a study protocol for a randomized control trial

Parnell

Zolin

et al. 2022

Trials

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Background More than half of patients undergoing paraesophageal hernia repair (PEHR) will have radiographic hernia recurrence at 5 years after surgery. Gastropexy is a relatively low-risk intervention that may decrease recurrence rates, but it has not been studied in a prospective manner. Our study aims to evaluate the effect of anterior gastropexy on recurrence rates after PEHR, compared to no anterior gastropexy. Methods This is a two-armed, single-blinded, registry-based, randomized controlled trial comparing anterior gastropexy to no anterior gastropexy in PEHR. Adult patients (≥18 years) with a symptomatic paraesophageal hernia measuring at least 5 cm in height on computed tomography, upper gastrointestinal series, or endoscopy undergoing elective minimally invasive repair are eligible for recruitment. Patients will be blinded to their arm of the trial. All patients will undergo laparoscopic or robotic PEHR, where some operative techniques (crural closure techniques and fundoplication use or avoidance) are left to the discretion of the operating surgeon. During the operation, after closure of the diaphragmatic crura, participants are randomized to receive either no anterior gastropexy (control arm) or anterior gastropexy (treatment arm). Two hundred forty participants will be recruited and followed for 1 year after surgery. The primary outcome is radiographic PEH recurrence at 1 year. Secondary outcomes are symptoms of gastroesophageal reflux disease, dysphagia, odynophagia, gas bloat, regurgitation, chest pain, abdominal pain, nausea, vomiting, postprandial pain, cardiovascular, and pulmonary symptoms as well as patient satisfaction in the immediate postoperative period and at 1-year follow-up. Outcome assessors will be blinded to the patients’ intervention. Discussion This randomized controlled trial will examine the effect of anterior gastropexy on radiographic PEH recurrence and patient-reported outcomes. Anterior gastropexy has a theoretical benefit of decreasing PEH recurrence; however, this has not been proven beyond a suggestion of effectiveness in retrospective series. If anterior gastropexy reduces recurrence rates, it would likely become a routine component of surgical PEH management. If it does not reduce PEH recurrence, it will likely be abandoned. Trial registration ClinicalTrials.gov NCT04007952. Registered on July 5, 2019.

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Outcome for Asymptomatic Recurrence Following Laparoscopic Repair of Very Large Hiatus Hernia

Abstract: Background: Radiological follow-up following repair of large hiatus hernias have

Cited by 17 publications

References 30 publications

Retrospective Review and Prospective Follow-up of 85 Consecutive Patients Treated With a Novel Hepatic-derived Surgical Mesh for Hiatal Hernia Repair: Outcomes, Surgical Complications, and Revisions

Retrospective Review and Prospective Follow-up of 85 Consecutive Patients Treated With a Novel Hepatic-derived Surgical Mesh for Hiatal Hernia Repair: Outcomes, Surgical Complications, and Revisions

Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

Comparing anterior gastropexy to no anterior gastropexy for paraesophageal hernia repair: a study protocol for a randomized control trial

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