Crural Closure improves Outcomes of Magnetic Sphincter Augmentation in GERD patients with Hiatal Hernia

Despite the increasing number of bariatric procedures being performed, the optimal strategy for managing the crura during laparoscopic sleeve gastrectomy (LSG) remains controversial. Options include no closure, primary suture closure, and suture closure with mesh reinforcement. We sought to investigate outcomes associated with each technique and determine if any approach proved to be superior. Methods This is a retrospective cohort study that evaluated patients undergoing LSG performed by a single surgeon in a 7-year period. Data were collected via chart review. The primary endpoint was hiatal hernia presence at 5 years post-operatively. Secondary endpoints included post-procedural complications (nausea, vomiting, dysphagia, or reflux) at 30 days post-operatively. Results A total of 361 patients were included in the analysis: 154 without crural closure, 164 primary crural closure, and 43 primary crural closure with mesh reinforcement. Rates of hiatal hernia occurrence at 5 years were 9.7% (no closure), 14.0% (primary closure), and 16.3% (closure with mesh reinforcement), respectively, and did not differ significantly among the 3 cohorts (P = .37). Overall rates of 30-day complications were 11.5%, 21.5%, and 28.6%, respectively ( P = .015). Conclusion Rates of hiatal hernia after sleeve gastrectomy do not differ, regardless of management of the crura. In addition, and perhaps more significantly, avoidance of crural closure was associated with fewer 30-day complications. In fact, the highest rate of 30-day complications was seen in the group that received closure with mesh reinforcement. These data suggest that crural closure during LSG should be avoided. Further prospective study of these findings is warranted.

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Hiatal hernia recurrence following magnetic sphincter augmentation and posterior cruroplasty: intermediate-term outcomes

Surgical Endoscopy ◽

10.1007/s00464-018-6059-6 ◽

2018 ◽

Vol 32 (7) ◽

pp. 3374-3379 ◽

Cited By ~ 14

Author(s):

Kais A. Rona ◽

James M. Tatum ◽

Joerg Zehetner ◽

Katrin Schwameis ◽

Carol Chow ◽

...

Keyword(s):

Hiatal Hernia ◽

Hernia Recurrence ◽

Magnetic Sphincter Augmentation ◽

Hiatal Hernia Recurrence

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Initial Experience with Laparoscopic Crural Closure in the Management of Hiatal Hernia in Obese Patients Undergoing Sleeve Gastrectomy

Obesity Surgery ◽

10.1007/s11695-009-0056-8 ◽

2010 ◽

Vol 20 (8) ◽

pp. 1149-1153 ◽

Cited By ~ 69

Author(s):

Emanuele Soricelli ◽

Giovanni Casella ◽

Mario Rizzello ◽

Benedetto Calì ◽

Giorgio Alessandri ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Hiatal Hernia ◽

Obese Patients ◽

Initial Experience ◽

Crural Closure

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Resorbable Biosynthetic Mesh for Crural Reinforcement during Hiatal Hernia Repair

The American Surgeon ◽

10.1177/000313481408001026 ◽

2014 ◽

Vol 80 (10) ◽

pp. 1030-1033 ◽

Cited By ~ 10

Author(s):

Evan T. Alicuben ◽

Stephanie G. Worrell ◽

Steven R. DeMeester

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Recurrent Hernia ◽

Synthetic Mesh ◽

Hiatal Hernia Repair ◽

Perioperative Morbidity ◽

Collis Gastroplasty ◽

Reduction Techniques ◽

Crural Closure

The use of mesh to reinforce crural closure during hiatal hernia repair is controversial. Although some studies suggest that using synthetic mesh can reduce recurrence, synthetic mesh can erode into the esophagus and in our opinion should be avoided. Studies with absorbable or biologic mesh have not proven to be of benefit for recurrence. The aim of this study was to evaluate the outcome of hiatal hernia repair with modern resorbable biosynthetic mesh in combination with adjunct tension reduction techniques. We retrospectively analyzed all patients who had crural reinforcement during repair of a sliding or paraesophageal hiatal hernia with Gore BioA resorbable mesh. Objective follow-up was by videoesophagram and/or esophagogastroduodenoscopy. There were 114 patients. The majority of operations (72%) were laparoscopic primary repairs with all patients receiving a fundoplication. The crura were closed primarily in all patients and reinforced with a BioA mesh patch. Excessive tension prompted a crural relaxing incision in four per cent and a Collis gastroplasty in 39 per cent of patients. Perioperative morbidity was minor and unrelated to the mesh. Median objective follow-up was one year, but 18 patients have objective follow-up at two or more years. A recurrent hernia was found in one patient (0.9%) three years after repair. The use of crural relaxing incisions and Collis gastroplasty in combination with crural reinforcement with resorbable biosynthetic mesh is associated with a low early hernia recurrence rate and no mesh-related complications. Long-term follow-up will define the role of these techniques for hiatal hernia repair.

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Videoesophagography versus Endoscopy for Prediction of Intraoperative Hiatal Hernia Size

The American Surgeon ◽

10.1177/000313481808400322 ◽

2018 ◽

Vol 84 (3) ◽

pp. 387-391 ◽

Cited By ~ 1

Author(s):

James M. Tatum ◽

Kamran Samakar ◽

Michael E. Bowdish ◽

Wendy J. Mack ◽

Nikolai Bildzukewicz ◽

...

Keyword(s):

Regression Analysis ◽

Cohort Study ◽

Laparoscopic Surgery ◽

Hiatal Hernia ◽

Retrospective Cohort ◽

Linear Regression Analysis ◽

Preoperative Assessment ◽

Magnetic Sphincter Augmentation ◽

Operative Assessment ◽

Hernia Size

Magnetic sphincter augmentation is a novel surgical procedure for gastroesophageal reflux disease. Limited dissection at the hiatus is one of the benefits of the procedure, but makes precise and accurate preoperative assessment of even small hiatal hernia critical. Retrospective cohort study of 136 patients having undergone both endoscopy (EGD) and videoesophagography followed by operative assessment for hiatal hernia during magnetic sphincter augmentation. The objective of the study is to determine which preoperative modality more accurately predicts operative hiatal hernia size. Videoesophagography underestimated operative measurement by 0.37 ± 1.41 cm ( P = 0.003) and was less accurate in predicting intraoperative hiatal hernia size than EGD on linear regression analysis (β -0.729, SE 0.057, P < 0.001). EGD was less accurate at predicting hiatal hernia size as patient age increased (β -0.018, SE 0.007, P = 0.014) and with larger hernias (β -0.615, standard error (SE) 0.067, P < 0.001); however, endoscopic measurements did not differ significantly from intraoperative measurements (0.93 ± 1.23 cm vs 1.12 ± 1.43 cm, P = 0.12). EGD better predicts the size of small hiatal hernia measured during subsequent laparoscopic surgery.

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Magnetic Sphincter Augmentation in Patients with Paraesophageal Hernia vs Large Sliding Hiatal Hernia: Comparison of Clinical Outcome and Complexity of the Surgery

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.052 ◽

2020 ◽

Vol 231 (4) ◽

pp. S26

Author(s):

Katrin Schwameis ◽

Shahin Ayazi ◽

Kristy L. Chovanec ◽

Adam Alleyne ◽

Xinxin Sherry Shen ◽

...

Keyword(s):

Clinical Outcome ◽

Hiatal Hernia ◽

Paraesophageal Hernia ◽

Magnetic Sphincter Augmentation ◽

Sliding Hiatal Hernia

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P169 COMPARISON OF LAPAROSCOPIC TOUPET FUNDOPLICATION AND MAGNETIC SPHINCTER AUGMENTATION IN PATIENTS WITH 3-5 CM HIATUS HERNIA

Diseases of the Esophagus ◽

10.1093/dote/doz092.169 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

V Lazzari ◽

P Milito ◽

R Scaramuzzo ◽

E Asti ◽

L Bonavina

Keyword(s):

Quality Of Life ◽

Hiatal Hernia ◽

Hiatus Hernia ◽

Barium Swallow ◽

Magnetic Sphincter Augmentation ◽

Toupet Fundoplication ◽

Laparoscopic Toupet Fundoplication ◽

Significant Difference ◽

Large Hiatus Hernia

Abstract Aim To compare quality of life in patients with large hiatus hernia undergoing laparoscopic Toupet fundoplication and magnetic sphincter augmentation. Background and Methods Laparoscopic Toupet fundoplication (LTF) and laparoscopic magnetic sphincter augmentation (MSA) have been compared in a previous retrospective study (Asti E et al, Medicine, 2016) in patients with small hiatal hernia (<3 cm). There is no universal consensus in the use of MSA in patients with large hiatus hernia. This is an observational, retrospective, comparative cohort study. Patients with <3 cm or >5 cm hiatus hernia measured by endoscopy and barium swallow study and those with previous esophago-gastric surgery were excluded. The primary outcome was quality of life based on the Gastro-Esophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) questionnaire. Secondary outcomes were proton pump inhibitors (PPI) use, incidence of dysphagia and gas-related symptoms, and hiatus hernia recurrence rate. Results Between March 2007 and June 2018, 150 patients with GERD met the inclusion criteria; 88 underwent a LTF and 62 a MSA procedure. Both groups had similar preoperative features. The mean follow-up was 64 months and all patients were followed for at least one year after surgery. There was no statistically significant difference between LTF and MSA in GERD-HRQL scores (p=0.178), PPI use (p=0.327), gas-related symptoms (p=0.162), dysphagia (p=0.254), and reoperation rate (p=0.167). Conclusion Both LTF and MSA have similar safety profile and disease-specific quality of life in patients with large hiatal hernia.

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Laparoscopic fixation of biological mesh at hiatus with glue and suture during hiatal hernia repair

BMC Surgery ◽

10.1186/s12893-021-01151-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yusheng Nie ◽

Yao Xiong ◽

Lei Guan ◽

Xin Yuan ◽

Fuqiang Chen ◽

...

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Recurrence Rate ◽

Mesh Fixation ◽

Retrospective Chart Review ◽

Biological Mesh ◽

Hiatal Hernia Repair ◽

Consecutive Series ◽

Crural Closure

Abstract Background Laparoscopic paraesophageal hernia repair is associated with higher recurrence rate. Mesh is used to reduce the recurrence rate. This retrospective study is to review our experience of biological mesh fixed with suture and medical glue in hiatal hernias repairs. Methods A retrospective chart review was conducted for a consecutive series of patients undergoing laparoscopic hiatal herniorrhaphy between January 2018 and January 2019. After hiatus closure, a piece of biological prosthesis was fixed with medical glue and suture for reinforcement of the crural closure. Clinical outcomes were reviewed, and data were collected regarding operative details, complications, symptoms, and follow-up imaging. Radiological evidence of any size of hiatal hernia was considered to indicate a recurrence. Results Thirty-six patients underwent surgery uneventfully without any serious complication. There was no mortality. The follow-up was, on average, 18.4 months, and there was no symptomatic recurrence. There was one anatomical recurrence without any related presentation. The method of mesh fixation with medical glue and suture took 12 min on average, and the handling was fairly easy. Conclusions Biological mesh fixed with suture and medical glue was safe and effective for repairing large hiatal hernias. Of course, a longer follow-up is still needed for determining long-term outcomes.

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