The use of biosynthetic mesh in giant hiatal hernia repair: is there a rationale? A 3‐year single‐center experience—author’s reply

Abstract Purpose Trans-hiatal herniation after esophago-gastric surgery is a potentially severe complication due to the risk of bowel incarceration and cardiac or respiratory complaints. However, measures for prevention and treatment options are based on a single surgeon´s experiences and small case series in the literature. Methods Retrospective single-center analysis on patients who underwent surgical repair of trans-hiatal hernia following gastrectomy or esophagectomy from 01/2003 to 07/2020 regarding clinical symptoms, hernia characteristics, pre-operative imaging, hernia repair technique and perioperative outcome. Results Trans-hiatal hernia repair was performed in 9 patients following abdomino-thoracic esophagectomy (40.9%), in 8 patients following trans-hiatal esophagectomy (36.4%) and in 5 patients following conventional gastrectomy (22.7%). Gastrointestinal symptoms with bowel obstruction and pain were mostly prevalent (63.6 and 59.1%, respectively), two patients were asymptomatic. Transverse colon (54.5%) and small intestine (77.3%) most frequently prolapsed into the left chest after esophagectomy (88.2%) and into the dorsal mediastinum after gastrectomy (60.0%). Half of the patients had signs of incarceration in pre-operative imaging, 10 patients underwent emergency surgery. However, bowel resection was only necessary in one patient. Hernia repair was performed by suture cruroplasty without (n = 12) or with mesh reinforcement (n = 5) or tension-free mesh interposition (n = 5). Postoperative pleural complications were most frequently observed, especially in patients who underwent any kind of mesh repair. Three patients developed recurrency, of whom two underwent again surgical repair. Conclusion Trans-hiatal herniation after esophago-gastric surgery is rare but relevant. The role of surgical repair in asymptomatic patients is disputed. However, early hernia repair prevents patients from severe complications. Measures for prevention and adequate closure techniques are not yet defined.

Download Full-text

Robotic giant hiatal hernia repair: 3 year prospective evaluation and review of the literature

International Journal of Medical Robotics and Computer Assisted Surgery ◽

10.1002/rcs.1595 ◽

2014 ◽

Vol 11 (1) ◽

pp. 1-7 ◽

Cited By ~ 14

Author(s):

Luca Morelli ◽

Simone Guadagni ◽

Maria Donatella Mariniello ◽

Roberta Pisano ◽

Cristiano D'Isidoro ◽

...

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Hiatal Hernia Repair ◽

Prospective Evaluation ◽

Review Of The Literature ◽

Giant Hiatal Hernia

Download Full-text

Gasless laparoscopic surgery plus abdominal wall lifting for giant hiatal hernia—our single-center experience

Journal of Huazhong University of Science and Technology [Medical Sciences] ◽

10.1007/s11596-016-1685-5 ◽

2016 ◽

Vol 36 (6) ◽

pp. 923-926 ◽

Cited By ~ 2

Author(s):

Jiang-hong Yu ◽

Ji-xiang Wu ◽

Lei Yu ◽

Jian-ye Li

Keyword(s):

Laparoscopic Surgery ◽

Abdominal Wall ◽

Hiatal Hernia ◽

Single Center ◽

Single Center Experience ◽

Giant Hiatal Hernia ◽

Abdominal Wall Lifting

Download Full-text

Situs inversus totalis: giant hiatal hernia repair by laparoscopic Collis gastroplasty and Nissen fundoplication

Surgical Endoscopy ◽

10.1007/s00464-003-4510-8 ◽

2004 ◽

Vol 18 (2) ◽

pp. 345-349 ◽

Cited By ~ 5

Author(s):

C. D. Hoang ◽

Y. G. Bakman ◽

S. Ikramuddin ◽

M. A. Maddaus

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Situs Inversus ◽

Nissen Fundoplication ◽

Situs Inversus Totalis ◽

Hiatal Hernia Repair ◽

Collis Gastroplasty ◽

Giant Hiatal Hernia

Download Full-text

RA06.03: SURGICAL OUTCOMES OF GIANT HIATAL HERNIA REPAIR IN PATIENTS OVER THE AGE OF 80

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra06.03 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 30-30

Author(s):

Oleksandr Khoma ◽

Miho Mugino ◽

Gregory Falk

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Hiatal Hernia ◽

Laparoscopic Fundoplication ◽

Conflicts Of Interest ◽

Hiatal Hernia Repair ◽

Post Operative Period ◽

Giant Hiatal Hernia

Abstract Background Patients with giant hiatal herniae are often symptomatic and have significantly reduced quality of life (QoL). Laparoscopic fundoplication is an established treatment of giant hiatal hernia. Advanced age has been previously shown to be the most significant predictor of mortality and morbidity in hiatal hernia repair. Reported outcomes of laparoscopic fundoplication in patients over the age of 80 are limited to case reports and small case series. Methods Data was extracted from a prospectively populated single surgeon database of laparoscopic fundoplication procedures between 1995 and 2014. Patients who were operated for giant HH (> 30% of stomach in the chest) that were aged 80 or older at the time of surgery were included. Quality of life (QOL) data was collected pre-operatively, in early post-operative period (within 12 months) and late post-operative period (24 months or later). QOL data included gastro-intestinal quality of life index (GIQLI), Visick score, dysphagia score and overall satisfaction with surgery. Search of Ryerson index (was conducted to establish month and year of death and calculate post-operative life expectancy. Results Inclusion criteria were met by 89 patients. Average age was 84 (80–93). The proportion of herniated stomach was 70.9% on average (range 30–100%; SD 27.25), the hiatal defect was large in all patients. There was 1 perioperative death from myocardial infarction at 30 days after surgery. There were no other major complications (Clavien-Dindo Grade III-IV). Post-operative survival was an average of 74.5 months (SD 47.8; range 1–233). GIQLI was reduced pre-operatively (mean 91.8; SD 19.4). There was improvement in GIQLI scores on early (mean 101.45; SD 21.2) and late (mean 106.7; SD 19.2; P = 0.005) post-operative follow up. Pre-operative Visick scores (mean 2.92; SD 0.98) have improved significantly in early (mean 1.94; SD 0.97; P = 0.000) and late (mean 2.03; SD 0.99; P = 0.001) post-operative periods. During early post-operative follow up 97% of the patients were satisfied with overall outcome of their operation, whilst 3% were dissatisfied. Overall satisfaction scores remained high on late follow up (93.3% satisfied, 6.7% dissatisfied). Conclusion Findings of this study demonstrate that in carefully selected patients with giant HH surgery is safe and results in improved quality of life post operatively. Disclosure All authors have declared no conflicts of interest.

Download Full-text