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.

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.

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

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 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.

The Use of Standardized Measures to Predict and Assess Quality of Life after Laparoscopic Hiatal Hernia Repair

2018 ◽  
Vol 84 (6) ◽  
pp. 789-795
Author(s):  
Mark Shapiro ◽  
Benjamin E. Lee ◽  
John R. Rutledge ◽  
Robert J. Korst
Keyword(s):  
Quality Of Life ◽  
Hernia Repair ◽  
Hiatal Hernia ◽  
Female Gender ◽  
Hiatal Hernia Repair ◽  
Outcome Instrument ◽  
Laparoscopic Hiatal Hernia Repair ◽  
Assess Quality ◽  
Hernia Size

The literature regarding laparoscopic hiatal hernia repair is difficult to interpret because of inconsistencies in describing hernia characteristics and outcome measures. This study was performed to evaluate risk factors for an unsatisfactory outcome after repair using objective definitions of hernia size and a clinically relevant outcome instrument. A retrospective review of a prospectively maintained database was conducted over a seven-year period. Data collected included patient demographics and hernia-related variables. Outcomes were defined using a validated quality of life (QOL) instrument. Postoperatively, the mean total QOL score decreased from 22.9 to 5.8 (P < 0.001). In all, 13.8 per cent of patients had unsatisfactory QOL scores postoperatively. Multivariate analysis showed that high gastroesophageal (GE) junction position (P = 0.03) and female gender (P = 0.02) were the only significant factors associated with an unsatisfactory postoperative QOL. Laparoscopic hiatal hernia repair significantly improves QOL. With respect to predicting clinically relevant outcomes, hernias are best characterized by the position of the GE junction. Females with high GE junction position are at the highest risk for an unsatisfactory outcome.

Equal patient satisfaction, quality of life and objective recurrence rate after laparoscopic hiatal hernia repair with and without mesh

2017 ◽  
Vol 31 (9) ◽  
pp. 3673-3680 ◽  
Author(s):  
Jan H. Koetje ◽  
Jelmer E. Oor ◽  
David J. Roks ◽  
Henderik L. Van Westreenen ◽  
Eric J. Hazebroek ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Hernia Repair ◽  
Hiatal Hernia ◽  
Recurrence Rate ◽  
Hiatal Hernia Repair ◽  
Laparoscopic Hiatal Hernia Repair

Comparative Analysis of Patients with Robotic Hiatal Hernia Repairs with and without Collis Gastroplasty

2021 ◽  
pp. 000313482198905
Author(s):  
John A. Perrone ◽  
Stephanie Yee ◽  
Manrique Guerrero ◽  
Antai Wang ◽  
Brian Hanley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Statistical Analysis ◽  
Hospital Stay ◽  
Hiatal Hernia ◽  
Collis Gastroplasty ◽  
Significant Difference ◽  
Related Quality

Introduction After extensive mediastinal dissection fails to achieve adequate intra-abdominal esophageal length, a Collis gastroplasty(CG) is recommended to decrease axial tension and reduce hiatal hernia recurrence. However, concerns exist about staple line leak, and long-term symptoms of heartburn and dysphagia due to the acid-producing neoesophagus which lacks peristaltic activity. This study aimed to assess long-term satisfaction and GERD-related quality of life after robotic fundoplication with CG (wedge fundectomy technique) and to compare outcomes to patients who underwent fundoplication without CG. Outcomes studied included patient satisfaction, resumption of proton pump inhibitors (PPI), length of surgery (LOS), hospital stay, and reintervention. Methods This was a single-center retrospective analysis of patients from January 2017 through December 2018 undergoing elective robotic hiatal hernia repair and fundoplication. 61 patients were contacted for follow-up, of which 20 responded. Of those 20 patients, 7 had a CG performed during surgery while 13 did not. There was no significant difference in size and type of hiatal hernias in the 2 groups. These patients agreed to give their feedback via a GERD health-related quality of life (GERD HRQL) questionnaire. Their medical records were reviewed for LOS, length of hospital stay (LOH), and reintervention needed. Statistical analysis was performed using SPSS v 25. Satisfaction and need for PPIs were compared between the treatment and control groups using the chi-square test of independence. Results Statistical analysis showed that satisfaction with outcome and PPI resumption was not significantly different between both groups ( P > .05). There was a significant difference in the average ranks between the 2 groups for the question on postoperative dysphagia on the follow-up GERD HRQL questionnaire, with the group with CG reporting no dysphagia. There were no significant differences in the average ranks between the 2 groups for the remaining 15 questions ( P > .05). The median LOS was longer in patients who had a CG compared to patients who did not (250 vs. 148 min) ( P = .01). The LOH stay was not significantly different ( P > .05) with a median length of stay of 2 days observed in both groups. There were no leaks in the Collis group and no reoperations, conversions, or blood transfusions needed in either group. Conclusion Collis gastroplasty is a safe option to utilize for short esophagus noted despite extensive mediastinal mobilization and does not adversely affect the LOH stay, need for reoperation, or patient long-term satisfaction.

532 OUTCOME OF QUILICI’S HEPATIC SHOULDER PROCEDURE TO AUGMENT LAPAROSCOPIC HIATOPLASTY IN LARGE OR RECURRENT HIATAL HERNIA

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Johannes Zacherl ◽  
Viktoria Kertesz ◽  
Cordula Höfle ◽  
Lisa Gensthaler ◽  
Bernhard Eltschka ◽  
...  
Keyword(s):  
High Risk ◽  
Hernia Repair ◽  
Hiatal Hernia ◽  
Laparoscopic Hernia Repair ◽  
Perioperative Complications ◽  
Recurrent Hernia ◽  
Hernia Recurrence ◽  
Hiatal Hernia Repair ◽  
Laparoscopic Hiatal Hernia Repair

Abstract   Laparoscopic hiatoplasty and fundoplication is the gold standard of surgical treatment of GERD and hiatal hernia. However, the main drawback of laparoscopic hiatal hernia repair is a substantial recurrence rate. Hence, prosthetic meshs have been used to reduce the risk for recurrence. But meshs may cause major complications. As a consequence we adopted the hepatic shoulder plasty described by Quilici to augment the hiatal hernia repair in patients with a high risk for hernia recurrence. Methods Patients with large (&gt;4 cm) axial hiatal hernia, giant paraesophageal or with recurrent hernia consecutively underwent laparoscopic hernia repair with crural sutures and hepatic shoulder plasty. A Toupet or a floppy Nissen fundoplication was added. In patients with giant paraesophageal hernia the hernia sack was resected. Perioperative complications were recorded. Follow-up comprised endoscopy and/or radiography and QoL-evaluation with the Eypasch score (GIQLI). Results Between 2012 and 2018 51 patients (mean age 71 years, 65% female) underwent Quilici’s procedure. Among them 33,3% had one or more previous hiatal hernia repair. There were no conversions. Postoperative complication rate was 7.8%. At follow-up after 2 years 6 recurrences (12%) were encountered, 4 of them were symptomatic (8%). One patient underwent reoperation due to hernia recurrence. In 84% QoL was significantly improved at follow-up. Conclusion In patients with high risk of recurrence, biological augmentation of the hiatal closure with the left lobe of the liver may be a valuable alternative to prosthetic reinforcement. We observed no complication attributable to liver lobe transposition.

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