Incidence of Delayed Gastric Emptying Associated with Revisional Laparoscopic Paraesophageal Hernia Repair

2012 ◽  
Vol 17 (2) ◽  
pp. 213-217 ◽  
Author(s):  
Miller Carlton Hamrick ◽  
Steven S. Davis ◽  
Amar Chiruvella ◽  
Rebecca L. Coefield ◽  
J. Patrick Waring ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Hernia Repair ◽  
Paraesophageal Hernia ◽  
Delayed Gastric Emptying ◽  
Paraesophageal Hernia Repair ◽  
Laparoscopic Paraesophageal Hernia Repair

Comparison between Laparoscopic Paraesophageal Hernia Repair with Sleeve Gastrectomy and Paraesophageal Hernia Repair Alone in Morbidly Obese Patients

2009 ◽  
Vol 75 (7) ◽  
pp. 620-625 ◽  
Author(s):  
Aziz M. Merchant ◽  
Michael W. Cook ◽  
Jahnavi Srinivasan ◽  
S. Scott Davis ◽  
John F. Sweeney ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Gastric Emptying ◽  
Hernia Repair ◽  
Antireflux Surgery ◽  
Paraesophageal Hernia ◽  
Delayed Gastric Emptying ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Paraesophageal Hernia Repair

Treatment options for morbidly obese patients with complications from large paraesophageal hernias (PEH) are limited. Simple repair of the PEH has a high recurrence rate and may be associated with poor gastric function. We compared a series of patients who underwent repair of large PEH plus gastrostomy tube gastropexy (PEH-GT) with PEH plus sleeve gastrectomy (PEHSG). Retrospective review of patients undergoing PEH-SG and patients with PEH-GT was performed. We assessed symptoms of delayed gastric emptying and reflux postoperatively. In selected patients, gastric-emptying studies and upper gastrointestinal contrast studies were also obtained. All patients with large PEH were repaired laparoscopically with sac resection, primary crural closure using pledgeted sutures, and biologic patch onlay. SG for patients undergoing concomitant weight loss surgery (PEH-SG) was performed with linear endoscopic staplers and staple line reinforcement. Patients undergoing PEH repair alone had a gastrostomy tube gastropexy (PEH-GT). Patients had intraoperative endoscopic evaluation and postoperative contrast swallow studies. In a 12-month period, five patients underwent laparoscopic PEH-SG; two of five had previous antireflux surgery and one of five with a previous diagnosis of delayed gastric emptying. Postoperatively, two patients undergoing PEH-SG had readmission for dehydration and odynophagia. Six-month follow-up body mass index was 32 kg/m2 for the PEH-SG group with no hernia recurrence and complete resolution of gastroesophageal reflux disorder symptoms. Six patients underwent PEH-GT, one for acute incarceration and anemia and four with previous antireflux surgery. Follow up at 8 months demonstrated one recurrence, four of six had severe delayed gastric emptying and reflux, three of six had additional hospitalization for poor oral intake, and three of six underwent reoperation for delayed gastric emptying. There were no perforations, leaks, or deaths in either group. Combined laparoscopic PEH-SG is a clinically reasonable option for patients with morbid obesity with minimal additional risks and decreased incidence of delayed gastric emptying, reflux, and reoperation.

The Need for Fundoplication at the Time of Laparoscopic Paraesophageal Hernia Repair

2013 ◽  
Vol 79 (6) ◽  
pp. 572-577 ◽  
Author(s):  
Lionel Van Der Westhuizen ◽  
Kaitlyn M. Dunphy ◽  
Brianna Knott ◽  
Alfredo M. Carbonell ◽  
Dane E. Smith ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Hiatal Hernia ◽  
Paraesophageal Hernia ◽  
Patient Characteristics ◽  
Hernia Recurrence ◽  
Paraesophageal Hernia Repair ◽  
Reflux Symptoms ◽  
Postoperative Reflux ◽  
Hiatal Hernia Recurrence ◽  
Laparoscopic Paraesophageal Hernia Repair

Most authors recommend an antireflux operation at the time of laparoscopic paraesophageal hernia (PEH) repair. A fundoplication combats the potential postoperative reflux resulting from disruption of the hiatal anatomy and may minimize recurrence. The purpose of this study is to evaluate the differences in postoperative dysphagia, reflux symptoms, and hiatal hernia recurrence in patients with and without a fundoplication at the time of laparoscopic paraesophageal hernia repair. Patients undergoing laparoscopic PEH repair from July 2006 to June 2012 were identified. Open repairs and reoperative cases were excluded. Patient characteristics, operative details, complications, and postoperative outcomes were recorded. Over the six-year period, 152 laparoscopic PEH repairs were performed. Mean age was 65.8 years (range, 31 to 92) and average body mass index was 29.9 kg/m2 (range, 18 to 52 kg/m2). Concomitant fundoplication was performed in 130 patients (86%), which was determined based on preoperative symptoms and esophageal motility. Mean operative times were similar with fundoplication (188 minutes) and without (184.5 minutes). At a mean follow-up of 13.9 months, there were 19 recurrences: 12.3 per cent (16 of 130) in the fundoplication group and 13.6 per cent (three of 22) in those without. Dysphagia lasting greater than six weeks was present in eight patients in the fundoplication group (6.2%) and in none in those without ( P = 0.603). Eighteen percent of patients without a fundoplication reported postoperative reflux compared with 5.4 per cent of patients with a fundoplication ( P = 0.055). In the laparoscopic repair of PEH, the addition of a fundoplication minimizes postoperative reflux symptoms without additional operative time. Neither dysphagia nor hiatal hernia recurrence is affected by the presence of a fundoplication.

scholarly journals Laparoscopic Paraesophageal Hernia Repair: Defining Long-Term Clinical and Anatomic Outcomes

2011 ◽  
Vol 140 (5) ◽  
pp. S-992
Author(s):  
Brant K. Oelschlager ◽  
Rebecca P. Petersen ◽  
L. Michael Brunt ◽  
Nathaniel J. Soper ◽  
Brett C. Sheppard ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Paraesophageal Hernia ◽  
Paraesophageal Hernia Repair ◽  
Laparoscopic Paraesophageal Hernia Repair
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