Objective Follow-up After Laparoscopic Repair of Large Type III Hiatal Hernia: Assessment of Safety and Durability

Abstract Background Many studies have shown that the importance of using mesh for paraesophageal hernia repair (PEHR) is to prevent recurrence. Unfortunately, it is associated with high risk of complications such as esophageal or gastric erosion. The aim of this study is to report the results of 38 patients who underwent laparoscopic PEHR with the use of a BioSynthetic mesh (GoreÒ Bio AÒ tissue Reinforcement.USA). Methods Observational, retrospective, single-center cohort study. We analysed retrospectively 38 consecutive patients with diagnosis of symptomatic Hiatal Hernia (HH) treated laparoscopically with an absorbable BioSynthetic mesh, between 2011–2017. The classic radiologic classification was used to classify the HH before surgery. This classification consists in four types/stages (I-IV). I: Sliding HH, II: Paraesophageal HH, III: Mixed form and IV: Intrathoracic stomach—upside-down hernia. All patients with Type III—IV hiatal hernia who underwent laparoscopic PEHR using an absorbable BioSynthetic mesh were included. We evaluated the results after PEHR with a symptoms questionnaire using a score 0–4 (Likert scale) and with an esophagogram and an esophagogastroduodenoscopy (EGD) analyzing the surgical success. Success was considered with symptomatic score improvement and/or absence of any symptomatic HH at the esophagogram and/or EGD. Results 38 patients: 7 males and 31 women. Median age: 66 (range 40–71). 12/38 (31,6%) patients had a type III HH and 26/38 (68,4%) a type IV. All these patients had been treated with a laparoscopic PEHR, using an absorbable BioSynthetic mesh as a reinforcement of the crura and Nissen fundoplication. The median follow-up was 12 months. 16/38 (42%) had a follow-up > 24 months. Success was evident in 95% of the patients. We observed 2 recurrences, one with a symptomatic type I HH and the other with an early type III HH recurrence. Conclusion The use of an absorbable synthetic mesh as a reinforcement of the crura in the treatment of the PEH has encouraging good results in the mild term follow up, with an extremely low incidence of complications. Disclosure All authors have declared no conflicts of interest.

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Assessment of short-term outcome with TiO2 mesh in laparoscopic repair of large paraesophageal hiatal hernias

BMC Surgery ◽

10.1186/s12893-019-0607-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Islam Khaled ◽

Pablo Priego ◽

Mohammed Faisal ◽

Marta Cuadrado ◽

Francisca García-Moreno ◽

...

Keyword(s):

Hiatal Hernia ◽

Laparoscopic Repair ◽

Postoperative Recurrence ◽

University Hospital ◽

Suture Repair ◽

Short Term ◽

Recurrence Rates ◽

Term Outcome ◽

Clinical Recurrence

Abstract Background Laparoscopic large para-oesophageal hiatal hernia (LPHH) repair using mesh reinforcement significantly reduces postoperative recurrence rates compared to conventional suture repair, especially within short follow-up times. However, the ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. The aim of this study was to survey our short-term results of LPHH management with a biosynthetic monofilament polypropylene mesh coated with titanium dioxide to enhance biocompatibility (TiO2Mesh™). Methods A retrospective study was performed at Ramon y Cajal University Hospital, Spain from December 2014 to October 2018. Data were collected on 27 consecutive patients with extensive hiatal hernia defects greater than 5 cm for which a laparoscopic repair was performed by primary suture and additional reinforcement with a TiO2Mesh™. Study outcomes were investigated, including clinical and radiological recurrences, dysphagia and mesh-related drawbacks. Results Twenty-seven patients were included in our analysis; 10 patients were male, and 17 were female. The mean age was 73 years (range, 63–79 years). All operations were performed laparoscopically. The median postoperative hospital stay was 3 days. After a mean follow-up of 18 months (range, 8-29 months), only 3 patients developed clinical recurrence of reflux symptoms (11%), and 2 had radiological recurrences (7%). No mesh-related complications occurred. Conclusions TiO2Mesh™ was found to be safe for laparoscopic repair of LPHH with a fairly low recurrence rate in this short-term study. Long-term studies conducted over a period of years with large sample sizes will be essential for confirming whether this mesh is suitable as a standard method of care with few drawbacks.

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Laparoscopic Management of Giant Type III Hiatal Hernia and Short Esophagus Objective Follow-Up at Three Years

Journal of Gastrointestinal Surgery ◽

10.1016/s1091-255x(01)00067-1 ◽

2002 ◽

Vol 6 (2) ◽

pp. 181-188 ◽

Cited By ~ 74

Author(s):

B Jobe

Keyword(s):

Hiatal Hernia ◽

Short Esophagus ◽

Laparoscopic Management ◽

Type Iii

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Laparoscopic management of giant type III hiatal hernia and short esophagus: Objective follow-up at three years

Gastroenterology ◽

10.1016/s0016-5085(01)80212-2 ◽

2001 ◽

Vol 120 (5) ◽

pp. A43-A43

Author(s):

B JOBE ◽

R AYE ◽

C DEVENEY ◽

L HILL

Keyword(s):

Hiatal Hernia ◽

Short Esophagus ◽

Laparoscopic Management ◽

Type Iii

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Laparoscopic management of giant type III hiatal hernia and short esophagus: Objective follow-up at three years

Gastroenterology ◽

10.1016/s0016-5085(08)80212-0 ◽

2001 ◽

Vol 120 (5) ◽

pp. A43

Author(s):

Blair A. Jobe ◽

Ralph W. Aye ◽

Clifford W. Deveney ◽

Lucius D. Hill

Keyword(s):

Hiatal Hernia ◽

Short Esophagus ◽

Laparoscopic Management ◽

Type Iii

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370 LAPAROSCOPIC HIATAL HERNIA REPAIR: INSIGHTS FROM A HIGH-VOLUME CENTER

Diseases of the Esophagus ◽

10.1093/dote/doaa087.87 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

L Giulini ◽

D Razia ◽

S Mittal

Keyword(s):

Quality Of Life ◽

Hiatal Hernia ◽

Laparoscopic Repair ◽

Operative Time ◽

High Volume ◽

Perioperative Outcomes ◽

Hiatal Hernia Repair ◽

Laparoscopic Hiatal Hernia Repair

Abstract When a hiatal hernia (HH) becomes symptomatic, surgical repair is indicated. The surgical procedure can be safely carried out laparoscopically with good results. However, it is unclear whether the size of the hernia affects perioperative outcomes. The aim of this study was to assess whether laparoscopic repair of large hiatal hernias (L-HH) has comparable results to laparoscopic repair of small hernias (S-HH). Methods After approval from the Institutional Review Board, a prospectively maintained database was reviewed for data on patients who underwent primary laparoscopic HH repair at our center between August 2016 and December 2019. All procedures were performed by a single surgeon (SKM). HHs were defined as “large” when at least 50% of the stomach was herniated through the hiatus. Data on perioperative results and mid-term follow-up were analyzed. The Clavien-Dindo (CD) classification was used to define complications. Results Of 170 identified patients, 55 had L-HH; 115 had S-HH. Mean ages were 72 ± 10 for L-HH and 61 ± 11.3 years for S-HH (p < 0.001). Median operative time was 95 (IQR, 80–110) and 75 minutes (IQR, 65–90) for L-HH and S-HH, respectively (p < 0.001). L-HH patients had longer hospital stays (median 2 vs 1 days, IQR 1–2 for both; p = 0.001) and more complications (12/55 [21.8%] vs 4/115 [3.5%]; p < 0.001) than S-HH patients. Two L-HH patients had CD grades IIIb and IVa. At follow-up (20.9 ± 8.7 months), gastroesophageal reflux disease quality of life scores were comparable between groups (6.4 ± 11.7 vs 5.2 ± 0; p = 0.9). Conclusion Laparoscopic HH repair is safe and feasible; however, is more technically challenging and is associated with longer operative time, longer hospital stay, and increased morbidity when performed as treatment for L-HH (ie, at least 50% of the stomach herniated through the hiatus). Nonetheless, good quality of life outcomes can be achieved at mid-term follow-up in both patients with S-HH and patients with L-HH who undergo treatment by an experienced surgeon.

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Robotic Versus Laparoscopic Approach to Hiatal Hernia Repair: Results After 7 Years of Robotic Experience

The American Surgeon ◽

10.1177/0003134820943547 ◽

2020 ◽

Vol 86 (9) ◽

pp. 1083-1087

Author(s):

Sean C. O’Connor ◽

Matthew Mallard ◽

Shivani S. Desai ◽

Francisco Couto ◽

Matthew Gottlieb ◽

...

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Clinical Outcomes ◽

Laparoscopic Repair ◽

Laparoscopic Approach ◽

Hiatal Hernia Repair ◽

Continuous Variables ◽

Recurrence Rates ◽

Robotic Hiatal Hernia Repair

Introduction Robotic hiatal hernia repair offers potential advantages over traditional laparoscopy, most notably enhanced visualization, improved ergonomics, and articulating instruments. The clinical outcomes, however, have not been adequately evaluated. We report outcomes of laparoscopic and robotic hiatal hernia repairs. Methods A retrospective observational cohort study was performed of all hiatal hernia repairs performed from 2006 through 2019. Operative, demographic, and outcomes data were compared between laparoscopic and robotic groups. Discrete variables were analyzed with Chi-square of Fisher’s exact test. Continuous variables were analyzed with Student’s t test (mean) or Wilcoxon rank sum (medians). All analyses were performed using R statistical software. Results Laparoscopic repair was performed in 278 patients and robotic repair in 114. More recurrent hernias were repaired robotically (24.5% vs 12.9%, P = .08). Operative times were no different between groups (175 vs 179 minutes; P = .681). Robotic repair resulted in significantly shorter length of stay (LOS; 2.3 vs 3.3 days; P = .003). Rate of readmission was no different, and there were no differences in acute complications. For patients with at least 1 year of follow-up, recurrence rates were lower after robotic repair (13.3% vs 32.8%; P = .008); however, mean follow-up is significantly longer after laparoscopic repair (23.7 ± 28.4 vs 15.1 ± 14.9 months; P < .001). Discussion Robotic hiatal hernia repair offers technical advantages over laparoscopic repair with similar clinical outcomes.

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Laparoscopic repair of large hiatal hernia with teres ligament: midterm follow-up

Surgical Endoscopy ◽

10.1007/s00464-007-9648-3 ◽

2007 ◽

Vol 22 (4) ◽

pp. 881-884 ◽

Cited By ~ 20

Author(s):

G. Varga ◽

L. Cseke ◽

K. Kalmar ◽

O. P. Horvath

Keyword(s):

Hiatal Hernia ◽

Laparoscopic Repair ◽

Large Hiatal Hernia

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