Patient-related risk factors associated with symptomatic recurrence requiring reoperation in laparoscopic hiatal hernia repair

Abstract

Background Recurrent hiatal hernia remains a challenge. Methods For initial repairs at our center: patients with 1 repair were compared to those who required reoperation for symptomatic recurrence. Subsequently, patients who had 1 repair at our center were compared to all patients who required reoperation (including initial repair at another center). Results There were 401 repairs: 308 primary repairs at our center and 93 reoperations, 287/308 (93%) required 1 repair and 21/308 (7%) required reoperation. Comparing 1 repair versus 21 reoperations, risk factors were abdominoplasty odds ratio = 32.0 (4.1–250.6), P < .001, postoperative lifting/vomiting odds ratio = 11.6 (3.2–42.1), P < .0002, tubal ligation odds ratio = 4.9 (1.1–22.6), P < .04 and height < 160 cm odds ratio = 3.9 (1.1–13.3) P < 0.03. Comparing 287 with 1 repair versus all 93 reoperations, risk factors were post-operative vomiting odds ratio = 22.7 (2.3–218.0), P < .007, abdominoplasty odds ratio = 5.6 (1.0–31.4), P < .0495, post-operative lifting odds ratio = 5.4 (2.2–12.9), P < .0002, age < 52 odds ratio = 3.6 (1.8–7.3), P < .0003, tubal ligation odds ratio = 3.2 (1.2–8.7), P < 0.019 and height < 160 cm odds ratio = 3.0 (1.5–6.1), P < 0.003. Conclusions Younger age, shorter stature, heavy lifting or vomiting after surgery, abdominoplasty and tubal ligation are risk factors associated with symptomatic recurrence requiring reoperation.

Gastroesophageal Reflux Disease: Critical Aspects of the History

“…In addition, it should be emphasized that those patients should pay careful attention to prevent heavy lifting following surgery which is an additional risk for recurrent hiatal hernia. 6…”

“…Abdominoplasty increases the intra-abdominal pressure and is associated with an increased risk of recurrent hiatal hernia, as we previously reported. 6 In addition, during laparoscopic surgery, the working space is smaller, and a higher insufflation pressure is required to achieve abdominal distention. Therefore, patients may have a higher chance of postoperative shoulder pain, which should be discussed with patients before antireflux surgery.…”

ERGE persistente o recidivante luego de cirugía antirreflujo, síntomas que llevan a la reintervención en un hospital privado de la Ciudad de México

“…Los elementos esenciales de una funduplicatura exitosa incluyen la reparación de la hernia hiatal y la plicatura infradiafragmática libre de tensión alrededor del esófago distal con una longitud de al menos 2-3 cm de esófago intraabdominal. 7,8 La persistencia de síntomas gastroesofágicos ha sido considerada sinónimo de falla quirúrgica, además de ser una indicación clara para reintervenir. 9 Las razones de falla están bien documentadas, por lo general se deben al pobre abordaje del paciente, selección incorrecta del tipo de procedimiento, errores técnicos o incluso deterioro de la motilidad esofagogástrica.…”