Short-Term Outcomes in Patients Undergoing Paraesophageal Hiatal Hernia Repair

Abstract

Many patients with hiatal hernias (HH) are asymptomatic; however, symptoms may include heartburn, regurgitation, dysphagia, nausea, or vague epigastric pain depending on the hernia type and severity. the ideal technique and timing of repair remains controversial. this report describes short-term outcomes and readmissions of patients undergoing HH repair at our institution. All patients who underwent HH repair from January 2012 through April 2017 were reviewed. Patients undergoing concomitant bariatric surgery were excluded. 239 patients were identified and 128 were included. Eighty-eight were female (69%) and 40 were male (31%) with a mean age of 59 years (range 20-91 years) and a mean BMI of 29.2 kg/m 2 (17-42). Worsening GERD was the most common presenting symptom in 79 (61.7%) patients. Eighty-four laparoscopic cases (65.6%) and 44 robotic assisted (34.4%) procedures were performed. Mesh was used in 59 operations (3 polytetrafluoroethylene; 56 biologic). All hiatal hernia types (I-IV) were collected. Majority were initial operations (89%). Techniques included: Toupet fundoplication in 68 cases (63.0%), Nissen fundoplication in 36 (33.3%), Dor fundoplication in 4 (3.7%), concomitant Collis gastroplasty in 4 (3.1%), and primary suture repair in 20 (15.6%). Outcomes between robotic and laparoscopic procedures were compared. Length of stay was reported as median and interquartile range for laparoscopic and robotic: 1.0 day (1.0-3.0) and 2.0 days (1.0-2.5); p = 0.483. Thirty-day readmission occurred in 9 patients, 7 (8.3%) laparoscopic and 2 (4.6%) robotic; p = 0.718. Two 30-day reoperations occurred, both laparoscopic; p = 0.545. Total of 16 complications occurred; 18.6% had a complication with the use of mesh compared to 8.7% without the use of mesh, p = 0.063. there were no conversion to open modality and no mortalities were reported. Hiatal hernia repair can be performed safely with a low incidence of complications.

Comparison of laparoscopic vs. robotic paraesophageal hernia repair: a systematic review

“…PEH, paraesophageal hernia; RAS, robotic assisted surgery; CLS, conventional laparoscopic surgery; SD, standard deviation, IQR, interquartile range. difference and even a possible increase in hospital stay in robotic PEH repair, but all these findings were statistically insignificant (2,(8)(9)(10).…”

“…A retrospective study by Soliman et al, on 293 patients who underwent elective PEH repair found significant reductions in complication rates in the robotic surgery group (6.3 vs. 19.2%), whereas three other studies state no significant difference in postoperative complication rate (2,10,11). No statistical difference was found in reoperations, readmission rates and mortality between the modes of MIS (2,11,12).…”

“…A hiatal hernia (HH) is the herniation of abdominal contents into the mediastinum through the diaphragm. There are four types of HHs (I–IV) ( 1 , 2 ). Paraesophageal hernia (PEH) is a rare (5–10% of all HHs) type of HH, in which the abdominal viscera herniates through the dilated diaphragmatic hiatus along with the esophagus ( 2 , 3 ).…”

“…There are four types of HHs (I–IV) ( 1 , 2 ). Paraesophageal hernia (PEH) is a rare (5–10% of all HHs) type of HH, in which the abdominal viscera herniates through the dilated diaphragmatic hiatus along with the esophagus ( 2 , 3 ). The incidence of PEH increases with age, thus with an aging population an increase in the overall incidence of PEH may be expected ( 3 ).…”

Comparison of laparoscopic Nissen and Dor fundoplication for gastroesophageal reflux disease and paraesophageal hernia: A case-control study

“…Laparoscopic anti-re ux surgery (LARS) is a widely-accepted treatment for gastroesophageal re ux disease (GERD), especially for those who have recurrent heartburn and regurgitation (1)(2)(3). Medicationrefractory GERD is often complicated by the presence of paraesophageal hernia (PEH) of varying severity; hernia repair is thus recommended as a supplementary treatment for fundoplication in LARS to reinforce treatment outcomes (1).…”