scholarly journals Robot-assisted vs. laparoscopic repair of complete upside-down stomach hiatal hernia (the RATHER-study): A prospective comparative single center study

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
F Nocera ◽  
A Wilhelm ◽  
R Schneider ◽  
L Koechlin ◽  
D Daume ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Hiatal Hernia ◽  
Laparoscopic Repair ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Hiatal Hernia Repair ◽  
Robot Assisted

Abstract Objective Complete upside-down stomach (cUDS) hernias are a subgroup of large hiatal hernias characterized by high risk of life-threatening complications and technically challenging surgical repair including complex mediastinal dissection. In a prospective, comparative clinical study, we evaluated intra- and postoperative outcomes, quality of life and symptomatic recurrence rates in patients with cUDS undergoing robot-assisted, as compared to standard laparoscopic repair (the RATHER-study). Methods All patients with cUDS herniation requiring elective surgery in our institution between July 2015 and June 2019 were evaluated. Patients undergoing primary open surgery or additional associated procedures were not considered. Primary endpoints were intra- and postoperative complications, 30-day morbidity, and mortality. During the 8-53 months follow-up period, patients were contacted by telephone to assess symptoms associated to recurrence, whereas quality of life was evaluated utilizing the Gastroesophageal Reflux Disease–Health-Related Quality of Life (GERD-HRQL) questionnaire. Results A total of 55 patients were included. 36 operations were performed with robot-assisted (Rob-G), and 19 with standard laparoscopic (Lap-G) technique. Patients characteristics were similar in both groups. Median operation time was 232 min. (IQR: 145-420) in robot-assisted vs. 163 min. (IQR:112-280) in laparoscopic surgery (p < 0.001). Intraoperative complications occurred in 5/36 (12.5%) cases in the Rob-G group and in 5/19 (26%) cases in the Lap-G group (p = 0.28). No conversion was necessary in either group. Minor postoperative complications occurred in 13/36 (36%) Rob-G patients and 4/19 (21%) Lap-G patients (p = 0.36). Mortality or major complications did not occur in either group. Two asymptomatic recurrences were observed in the Rob-G group only. No patient required revision surgery. Finally, all patients expressed satisfaction for treatment outcome, as indicated by similar GERD-HRQL scores. Conclusion While robot-assisted surgery provides additional precision, enhanced visualization, and greater feasibility in cUDS hiatal hernia repair, its clinical outcome is at least equal to that obtained by standard laparoscopic surgery.

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

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.

Laparoscopic Surgery for Recurrent Hiatal Hernia: Clinical Outcomes and Quality of Life

2021 ◽  
Author(s):  
Andrea Lovece ◽  
Andrea Sironi ◽  
Emanuele Asti ◽  
Pamela Milito ◽  
Sara Boveri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Surgery ◽  
Hiatal Hernia ◽  
Clinical Outcomes ◽  
Recurrent Hiatal Hernia

Resolution of anemia and improved quality of life following laparoscopic hiatal hernia repair

2019 ◽  
Vol 34 (7) ◽  
pp. 3072-3078 ◽  
Author(s):  
Alex Addo ◽  
Andrew Broda ◽  
H. Reza Zahiri ◽  
Ian M. Brooks ◽  
Adrian Park
Keyword(s):  
Quality Of Life ◽  
Hernia Repair ◽  
Hiatal Hernia ◽  
Hiatal Hernia Repair ◽  
Laparoscopic Hiatal Hernia Repair

Primary versus redo paraesophageal hiatal hernia repair: a comparative analysis of operative and quality of life outcomes

2017 ◽  
Vol 31 (12) ◽  
pp. 5166-5174 ◽  
Author(s):  
H. Reza Zahiri ◽  
Adam S. Weltz ◽  
Udai S. Sibia ◽  
Neethi Paranji ◽  
Steven D. Leydorf ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Comparative Analysis ◽  
Hernia Repair ◽  
Hiatal Hernia ◽  
Hiatal Hernia Repair ◽  
Life Outcomes ◽  
Quality Of Life Outcomes ◽  
Paraesophageal Hiatal Hernia

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

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.

scholarly journals Comparison of clinical outcomes and postoperative quality of life after surgical treatment of type II submucous myoma via laparoscopy or hysteroscopy

2019 ◽  
Vol 47 (9) ◽  
pp. 4126-4133
Author(s):  
Rui-chun Zhang ◽  
Wei Wu ◽  
Qing Zou ◽  
Hongmei Zhao
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Surgery ◽  
Clinical Outcomes ◽  
Intraoperative Complications ◽  
Type Ii ◽  
Intraoperative Bleeding ◽  
Laparoscopy Group ◽  
Operative Duration ◽  
Submucous Myoma

Objective This study was performed to compare the clinical outcomes, advantages, and disadvantages of laparoscopic myomectomy (LM) and transcervical resection of myoma (TCRM) in the treatment of type II submucous myoma. Methods In total, 136 patients with type II submucous myoma with a tumour diameter of 4 to 5 cm were randomly assigned to the hysteroscopy group or laparoscopy group. Results The operative duration was shorter and the intraoperative bleeding volume was lower in the hysteroscopy than laparoscopy group. The success rate of the single-stage operation was obviously higher in the laparoscopy than hysteroscopy group. The duration of postoperative antibiotic use and the length of hospital stay were shorter in the hysteroscopy than laparoscopy group. The time to complete healing of the muscle layer was shorter in the hysteroscopy than laparoscopy group. The rate of intraoperative complications was lower in the hysteroscopy than laparoscopy group. Conclusion Both hysteroscopic and laparoscopic surgery have beneficial effects in the treatment of type II submucous myoma. Hysteroscopic surgery has the advantages of a short operative duration, low intraoperative bleeding volume, fast postoperative recovery, and high quality of life. Laparoscopic surgery involves many intraoperative complications and slow recovery of ovarian function.

scholarly journals Pure Laparoscopic Living Donor Hepatectomy With/Without Fluorescence-Assisted Technology and Conventional Open Procedure: A Retrospective Study in Mainland China

2021 ◽  
Vol 8 ◽  
Author(s):  
Kang He ◽  
Yixiao Pan ◽  
Hai Wang ◽  
Jianjun Zhu ◽  
Bijun Qiu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Open Surgery ◽  
Living Donor ◽  
Operation Time ◽  
Fluorescence Technique ◽  
Donor Liver ◽  
Donor Hepatectomy

Background: The application of laparoscopy in donor liver acquisition for living donor liver transplantation (LDLT) has become increasingly popular in the past decade. Indole cyanide green (ICG) fluorescence technique is a new adjuvant method in surgery. The purpose was to compare the safety and efficacy of laparoscopic and open surgery in living donor left lateral hepatectomy, and to evaluate the application of ICG in laparoscopy.Methods: Donors received LDLT for left lateral lobe resection from November 2016 to November 2020 were selected and divided into pure laparoscopy donor hepatectomy (PLDH) group, fluorescence-assisted pure laparoscopy donor hepatectomy (FAPLDH) group and open donor hepatectomy (ODH) group. We compared perioperative data and prognosis of donors and recipients. Quality of life were evaluated by SF-36 questionnaires.Results: The operation time of PLDH group (169.29 ± 26.68 min) was longer than FAPLDH group (154.34 ± 18.40 min) and ODH group (146.08 ± 25.39 min, p = 0.001). The blood loss was minimum in FAPLDH group (39.48 ± 10.46 mL), compared with PLDH group (52.44 ± 18.44 mL) and ODH group (108.80 ± 36.82 mL, p=0.001). The post-operative hospital stay was longer in PLDH group (5.30 ± 0.98 days) than FAPLDH group (4.81 ± 1.03 days) and ODH group (4.64 ± 1.20 days; p = 0.001). Quality of life of donors undergoing laparoscopic surgery was better.Conclusion: Laparoscopic approaches for LDLT contribute to less blood loss, better cosmetic satisfaction. The fluorescence technique can further reduce bleeding and shorten operation time. In terms of quality of life, laparoscopic surgery is better than open surgery. Laparoscopy procedure for living-donor procurement with/without fluorescence-assist can be performed as safely as open surgery.

scholarly journals P-BN11 Patient Reported Outcomes of Phasix™ ST Mesh for Laparoscopic Hiatal Hernia Repair

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Yan Yu Tan ◽  
Sri Vishnu Thulasiraman ◽  
Phanibhushana Munipalle ◽  
Yirupaiahgari Viswanath
Keyword(s):  
Quality Of Life ◽  
Hernia Repair ◽  
Hiatal Hernia ◽  
Patient Reported Outcomes ◽  
Hiatal Hernia Repair ◽  
Complication Rates ◽  
Laparoscopic Hiatal Hernia Repair ◽  
Patient Reported

Abstract Background Laparoscopic hiatal hernia repair continues to suffer from high recurrence rates, which has prompted the use of mesh reinforcement by some surgeons. Use of mesh however remains controversial due to its association with complications such as erosion, fibrosis and oesophageal stenosis. Biosynthetic Poly-4-Hydroxybutyrate Phasix™ ST mesh is an emerging technology which combines the durability of synthetic mesh with the remodelling characteristics of biologic mesh and includes an anti-adhesion hydrogel barrier. There is a paucity of patient reported outcome data for Phasix™ ST mesh. This study evaluates early patient reported outcomes following laparoscopic hiatal hernia repair with Phasix™ ST mesh. Methods Adult patients undergoing laparoscopic hiatal hernia repair with Phasix™ ST mesh between July 2020 to June 2021 at our institution were identified. Prospective data, including demographic data and complication rates, was collected from electronic and paper medical records. The 12-Item Short Form Survey (SF-12) was administered to assess quality of life pre-operatively and post-operatively with a minimum 30-day follow-up. Results Fourteen patients (12 female, one male) were included with a median age of 66 years (range 52-79). There were no intraoperative complications, mesh-related complications, re-operation, re-admission, or recurrence at a median follow-up of 4 months (IQR 4.0). Median physical health component (PHC) score was 32.7 (IQR 6.2) at baseline and increased to 41.6 (IQR 13.7) post-operatively. Median difference in PHC score was +11.4 (IQR 10.7). Median mental health component (MHC) score was 39.8 (IQR 12.5) at baseline and increased to 57.4 (IQR 8.2) post-operatively. Mean difference in MHC score was +17.7 (IQR 15.9). Conclusions To our knowledge, this is the first report of outcomes on the use of Phasix™ ST mesh for laparoscopic hiatal hernia repair in the United Kingdom. Our study found that it is associated with improvements in both physical and mental quality of life in the short-term post-operative follow-up, although there is some variation in the degree of improvement reported.

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