PS01.049: ENDOSTIM™ NON-RESPONDERS: AN ANALYSIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 63-64
Author(s):  
Florian Matthias Corvinus ◽  
Edin Hadzijusufovic ◽  
Benjamin Babic ◽  
Hauke Lang ◽  
Peter Grimminger
Keyword(s):  
Quality Of Life ◽  
Hiatal Hernia ◽  
Conflicts Of Interest ◽  
Symptom Relief ◽  
Symptom Control ◽  
Long Term Results ◽  
Barium Swallow ◽  
Technical Failure ◽  
Postoperative Reflux

Abstract Background Electronic stimulation oft the lower esophageal sphincter (LES) is a new promising anti-reflux procedure that is established in Germany since 2014. Basically two leads are inserted laparoscopicaly into the LES and connected to an implantable pulse generator (IPG) which is placed in a subcutaneous pocket. This stimulation is supposed to build up the muscular anti-reflux barrier. It is limited to patients with a small hiatal hernia < 3 cm and reflux esophagitis LA Classification Type A-C. Although long-term results up to 4 years with a good postoperative reflux control and an increased quality of life have been published, no data about Endostim™ non-responders, difficult postoperative situations and procedure failure has been reported yet. Methods Between 12/2015 and 11/2017 12 patients underwent laparoscopy for an Endostim™ implantation. All patients had an upper endoscopy, a barium swallow, high-resolution esophageal impedance manomentry (HRIM), 24-hour multi-channel impedance and pH monitoring (MII-pH) prior to the procedure and after 6 months. The quality of life was assessed with the GERD health related quality of life (GERD-HRQL) questionnaire preoperatively and during further follow-up. Results 6 of 12 patients (50%), 2 female 4 male, reported new GERD symptoms after an initial postoperative symptom relief. 1 patient had a prolonged period (15 months) of reprogramming until complete symptom control was achieved. 1 patient had a recurrent 3 cm hiatal hernia after 3 months, so that only a partial responds was reported. In 2 patients reprogramming could not reach a proper responds. Two patients showed a complete technical failure due to a broken lead close to the IPG. Conclusion Reasons for Endostim™ failure can be heterogeneous. Because it is a young and new procedure non-responders should be investigated closely so that there can be a critical discussion about indications, contraindications and negative predictive factors. Disclosure All authors have declared no conflicts of interest.

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.

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

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.

PS01.024: ENDOSTIMTM THERAPY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 57-57
Author(s):  
Florian Matthias Corvinus ◽  
Edin Hadzijusufovic ◽  
Benjamin Babic ◽  
Hauke Lang ◽  
Peter Grimminger
Keyword(s):  
Quality Of Life ◽  
Esophageal Motility ◽  
Conflicts Of Interest ◽  
Ph Monitoring ◽  
Esophageal Motility Disorders ◽  
Barium Swallow ◽  
Motility Disorders ◽  
Validated Questionnaire ◽  
Retrosternal Pain

Abstract Background Electric stimulation of the lower esophageal sphincter is a new surgical option for patients with gastroesophageal reflux disease (GERD) and a diaphragmatic hernia less than 3 cm. In comparison to standard anti-reflux procedures like Nissen or Toupet fundoplication the procedure`s advantage is that there had been no report on postoperative dysphagia. Esophageal motility disorders can increase the risk of dysphagia after fundoplication. Therefor EndostimÔ might be an alternative for these patients. Methods Between December 2015 and November 2017 twelve patients with GERD received Endostim™ therapy. All patients underwent endoscopy, high resolution impedance manometry (HRIM), 24 hour impedance pH-monitoring and a barium swallow. Quality of life was assessed by GERD-HRLQ a validated questionnaire. Results Seven patients with an esophageal motility disorder received an Endostim™ due to symptomatic GERD. Three patients had an esophageal hypomotility, 2 patients had a CREST syndrome and 2 patients showed a functional outflow obstruction in HRIM. There were no postsurgical complications. No dysphagia, regurgitation or retrosternal pain was reported. After a follow up of 6 months all patients are satisfied with the procedure and report an increase of their quality of life. Conclusion These results demonstrate the feasibility of an Endostim™ therapy in patients with esophageal motility disorders for the first time. Disclosure All authors have declared no conflicts of interest.

REDO LAPAROSCOPIC ANTIREFLUX SURGERY IN PATIENTS WITH HIATAL HERNIA

2020 ◽  
pp. 36-39
Author(s):  
V. V. Grubnik ◽  
V. V. Grubnik ◽  
M. R. Paranyak
Keyword(s):  
Quality Of Life ◽  
Hiatal Hernia ◽  
Antireflux Surgery ◽  
Laparoscopic Antireflux Surgery ◽  
Long Term Results ◽  
Long Term Follow Up ◽  
Antireflux Operations

Summary. The purpose was to study the features and results of redo laparoscopic antireflux surgery in our clinic. Materials and methods. For the period from 2008 to 2019, in our clinic, laparoscopic antireflux operations were performed in 1164 patients. 54 patients underwent laparoscopic reoperation during the study period based on the following indications: recurrence of hiatal hernia (n = 38), recurrent reflux (n = 4), dysphagia (n = 8), severe pain (n = 5). All patients underwent repeated examinations in our clinic, telephone interviews, mailing of special questionnaires. All complaints were recorded, the quality of life was determined according to the GERD-HRQL questionnaire. Results. All redo operations were performed laparoscopically without conversion to laparotomy. Intraoperative complications were observed in 11.11 % of patients. Long-term follow up from 6 months to 6 years was observed in 90.74 % of patients. The quality of life of patients according to the GERD-HRQL questionnaire significantly improved in long-term follow-up (p <0.001). Good results were observed in 91.84 % of patients after redo operations. The third operation was needed in 5.6 % of patients. Conclusion. Redo laparoscopic antireflux operations are technically difficult surgical interventions, and should be performed by surgeons with big experience in the antireflux surgery. Laparoscopic antireflux surgery provide good long-term results in 90 % of patients.

Quality of life after anti-reflux surgical interventions: possible solutions to the problem

2020 ◽  
pp. 3-25
Author(s):  
D. Lukanin ◽  
G. Rodoman ◽  
M. Klimenko ◽  
A. Sokolov ◽  
A. Sokolov
Keyword(s):  
Quality Of Life ◽  
Hiatal Hernia ◽  
Antireflux Surgery ◽  
Nissen Fundoplication ◽  
Laparoscopic Nissen Fundoplication ◽  
Partial Fundoplication ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Laparoscopic Nissen

The article presents the results of a prospective controlled parallel clinical study of a new modification of laparoscopic antireflux surgery in the treatment of gastroesophageal reflux disease in combination with a hiatal hernia compared with laparoscopic Nissen fundoplication in terms of assessing quality of life after surgery. Clinical and instrumental examination of patients was carried out a year after surgical interventions. In accordance with the results of instrumental examination after surgery, the proposed modification of laparoscopic partial fundoplication is not inferior to laparoscopic Nissen fundoplication both, in terms of relief of reflux esophagitis symptoms and in relation to the recurrence of hiatal hernia. Clinical monitoring indicates a significantly higher quality of life for patients after the modified antireflux surgery, which is associated with a number of factors. The implementation of this fundoplication led to a decrease in the number of patients with complaints of dysphagia, the development of which is directly related to the surgery performance, as well as to a statistically significant reduction of bloating in the upper abdomen. Another advantage of the modified surgery is a significantly smaller number of cases of gas-bloat syndrome. In addition, the disorders developing in the framework of the gas bloat syndrome after laparoscopic Nissen fundoplication are more severe.

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.

Effectiveness analysis of the new method of antireflux surgery in patients with hiatal hernia

2020 ◽  
Vol 26 (4) ◽  
pp. 50-55
Author(s):  
A.R. Stasyshyn ◽  
◽  
A.A. Hurayevskyy ◽  
Yu.Y. Holyk ◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Los Angeles ◽  
Hiatal Hernia ◽  
Antireflux Surgery ◽  
New Method ◽  
Life Questionnaire ◽  
Post Surgery ◽  
Group I ◽  
Significant Difference

Aim. To analyze the effectiveness of a new method of antireflux surgery in patients with hiatal hernia. Materials and Methods. The results of treatment of 157 patients with hiatal hernia from 2016 to 2020 are analyzed. The patients were divided into 3 groups: group I, N=59, underwent laparoscopic antireflux operation modified by the authors (Patent of Ukraine № 59772); group II (N=77), underwent laparoscopic Nissen fundoplication; and group III (N=21) - laparoscopic Toupet fundoplication. Results and Discussion. At 36 months post-surgery follow-up, there was a statistically significant difference in favor of group I on the average scores of the visual analog scale for reflux symptoms, dysphagia and extraesophageal symptoms; the average quality of life questionnaire scores; the average DeMeester index; distribution of the patients by satisfaction; distribution of the patients by degree of reflux esophagitis according to the Los Angeles classification; and distribution by gas-bloat syndrome. Conclusions. Clinical application of the developed new method of laparoscopic surgery for hiatal hernia reduces the number of relapses and complications after surgery, and improves the quality of life of patients. Key words: hiatal hernia, antireflux surgery, new methods of treatment

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