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.

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

470 OUTCOMES OF COMPOSITE REPAIR OF GIANT HIATAL HERNIA IN A LARGE SINGLE CENTRE COHORT.

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
F Lee ◽  
O Khoma ◽  
M Mendu ◽  
G Falk
Keyword(s):  
Quality Of Life ◽  
Hiatus Hernia ◽  
Revision Surgery ◽  
Hernia Recurrence ◽  
Barium Swallow ◽  
Single Centre ◽  
Composite Repair ◽  
Perioperative Morbidity ◽  
Giant Hiatal Hernia

Abstract   Giant hiatus hernia (GHH) is usually symptomatic and can have significant impact on a patient’s quality of life. There is ongoing debate about optimal technique of giant hiatus hernia repair. This paper aims to look at the outcomes of laparoscopic composite repair of giant hiatus hernia from a large single centre cohort. Methods A retrospective analysis of prospectively maintained database was performed. Patients undergoing composite repair for GHH defined as &gt;30% stomach above diaphragm were included. Primary outcome was hernia recurrence. Secondary outcomes were perioperative morbidity and mortality, correlation of symptoms and hernia recurrence post operatively, need for revision surgery, resolution of symptoms post operatively and patient self-reported quality of life (GIQOL, Visik score). Results Inclusion criteria were met by 221 patients. Post-operative endoscopic and/or barium swallow follow up was performed in 198 patients with 23.74% recurrence rate. There was no correlation with recurrence of hernia and persistent post-operative symptoms. The most common presenting symptom was shortness of breath, followed by dysphagia, chest pain and heartburn. Dysphagia was most common post-operative symptom. There was significant improvement in QOL post-operatively. Conclusion Laparoscopic composite repair was proven safe and effective in this cohort. Hernia recurrence was not associated with ongoing symptoms and did not have an effect on QOL. A small proportion of patients with recurrence required revision surgery. Overall satisfaction with surgery was high.

633 CONVERSION TO TOUPET FUNDOPLICATION WITH DISTAL GASTRECTOMY AND ROUX-EN-Y GASTROJEJUNOSTOMY AFTER FAILED NISSEN FUNDOPLICATION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Italo Braghetto ◽  
Owen Korn ◽  
Manuel Figueroa ◽  
Carlos Mandiola ◽  
Ana Maria Burgos ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Distal Gastrectomy ◽  
Nissen Fundoplication ◽  
Acid Reflux ◽  
Laparoscopic Nissen Fundoplication ◽  
Barium Swallow ◽  
Toupet Fundoplication ◽  
Laparoscopic Toupet Fundoplication ◽  
Reflux Symptoms ◽  
Laparoscopic Nissen

Abstract   Laparoscopic Nissen Fundoplication fails in almost 15% of patients and most of them must be re-operated in order to improve reflux symptoms, esophagitis, or hiatal hernia. Surgical options are to redo LNF, distal gastrectomy alone or combination of both procedures. Redoing LNF, is associated with high rate of postoperative complications and re-failure. Purpose To present the early and medium-term postoperative outcomes of patients submitted to Laparoscopic Toupet Fundoplication combined with Distal Gastrectomy with Roux-en-Y gastrojejunostomy. Methods prospective study including 23 patients submitted to Laparoscopic Nissen Fundoplication who presented recurrence of gastroesophageal reflux after the operation. They were studied with endoscopy, barium swallow, manometry and 24 h pH monitoring in order to determine presence of esophagitis, anatomical deformities, defective Lower Esophageal Sphincter and pathologic acid reflux. Surgical process consisted on re-establishing the anatomy of the esophago-gastric junction, and then perform laparoscopic Toupet fundoplication combined with distal gastrecvtomy and Roux Y gastrojejunostomy. Results After surgery statistically significant improvement regarding heartburn (p &lt; 0.0001), dysphagia (p &lt; 0.0001) and retrosternal chest pain (p &lt; 0.0001) as well as in the endoscopic esophagitis was observed. No significant LES pressure increase after the operation was observed. (from 7.88 + 2.7 to 10.5 + 3.36) (p = 0.15), but the abnormal acid reflux improved significantly after the reoperation, %time pH &lt; 4 decreases from 12.00 + 6.62 to 4.3 + 4.04 (0.0004) and DeMeester score from 44.82 + 21.8 to 11.95 + 5.14 (0.0008) respectively. Conclusion The proposed procedure is safe option to treat successfully patients after failed Nissen fundoplication. Reflux symptoms, esophagitis, presence oh hiatal hernia and reflux score improved after the procedure.

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.

P177 REINFORCED CRURAL REPAIR FOR LARGE HIATUS HERNIA: PRELIMINARY RESULTS WITH PHASIX ST® MESH

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Tonucci T Panici ◽  
A Sironi ◽  
V Lazzari ◽  
C G Riva ◽  
P Milito ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hiatus Hernia ◽  
Recurrent Hernia ◽  
Morbidity Rate ◽  
Barium Swallow ◽  
Research Database ◽  
Swallow Study ◽  
Crural Repair

Abstract Aim The aim of the study was to assess safety, quality of life and recurrence rate after laparoscopic repair of hiatal hernia reinforced with a biosynthetic absorbable mesh (PHASIX ST®). Background & Methods Safety and effectiveness of absorbable meshes for laparoscopic hiatus hernia repair are still debated, with several studies reporting conflicting outcomes. This may be due to patient selection, technique of repair, type of mesh, definition of recurrent hernia and length of follow up. An observational, single-center study was conducted in patients undergoing laparoscopic crural repair reinforced with PHASIX ST®, a monofilament resorbable mesh (poly-4-hydroxybuterate) with a hydrogel barrier on one side. Data were extracted from hospital charts and a prospectively updated research database. The quality of life was assessed by the GastroEsophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaire. Clinical evaluation, upper gastrointestinal endoscopy and/or barium swallow study were performed at 6 – 24 months of follow up. Recurrent hernia was defined as the maximum vertical height of stomach > 2 cm above diaphragm at endoscopy and/or barium swallow study. Results 103 consecutive patients were implanted with PHASIX ST® mesh from January 2017 to May 2019. The overall postoperative morbidity rate was 2.9%. The average follow up was 13 months with 31 (30%) patients reaching 2-year. The mean postoperative GERD-HRQL score significantly improved compared to baseline (4.6 ± 3.9 vs 16.6 ± 4.1, p<0,001). Recurrent hernia was found in 3 of 79 (3.8%) patients followed for at least 6 months after surgery. None of the patients required reoperation for adverse events or symptomatic hernia recurrence. Conclusion The use of PHASIX ST® mesh to reinforce crural repair for large hiatus hernias is safe and seems to be effective in the short-term follow up.

Impact of Laparoscopic Repair of Large Hiatus Hernia on Quality of Life: Observational Cohort Study

2018 ◽  
Vol 36 (5) ◽  
pp. 402-408 ◽  
Author(s):  
Stefano Siboni ◽  
Emanuele Asti ◽  
Pamela Milito ◽  
Gianluca Bonitta ◽  
Andrea Sironi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Hiatus Hernia ◽  
Laparoscopic Repair ◽  
Partial Fundoplication ◽  
Hrql Score ◽  
Sf 36 ◽  
Large Hiatus Hernia

Background: Laparoscopic surgery has proven safe and effective in the treatment of large hiatus hernia. Differences may exist between objectively assessed surgical outcomes, symptomatic scores, and patient-reported outcomes. Methods: An observational, single-arm cohort study was conducted in patients undergoing primary laparoscopic repair with crura mesh augmentation and Toupet fundoplication for large (> 50% of intrathoracic stomach) type III–IV hiatus hernia. Data were extracted from hospital charts and a prospectively updated research database. The main study outcome was quality of life assessed by the Gastroesophageal reflux disease Health-Related Quality of Life (GERD-HRQL) score and the Short-form 36 (SF-36). Results: Between 2013 and 2016, 37 out of 49 operated patients completed the comprehensive quality-of-life evaluation at the 2-year follow-up. The GERD-HRQL score significantly decreased compared to baseline (p < 0.001). All items of the SF-36 significantly improved compared to baseline (p < 0.05). Both Physical and Mental Component Summary scores were significantly higher than preoperative scores, with a medium Cohen’s effect size (–0.77 and 0.56, respectively). At the 2-year follow-up, symptoms had disappeared in the majority of patients. The use of proton-pump inhibitors significantly decreased compared to baseline (13.5 vs. 86.4%, p < 0.001). Also, the use of antidepressants and benzodiazepines significantly decreased after surgery (8.1 vs. 32.4%, p < 0.001). The overall alimentary satisfaction score was > 8 in 92% of patients. There were no safety issues related to the use of the absorbable synthetic mesh. The incidence of anatomical hernia recurrence was 5.4%, but no patient with recurrent hernia required surgical revision. Conclusions: Laparoscopic repair of large hiatus hernia with mesh and partial fundoplication is associated with symptomatic relief, no side-effects, and a significant improvement in disease-specific and generic quality of life at 2-year follow-up.

scholarly journals Expanded Indication for Magnetic Sphincter Augmentation: Outcomes in Weakly Acidic Reflux Compared to Standard GERD Patients

2021 ◽  
Author(s):  
Milena Nikolic ◽  
Aleksa Matic ◽  
Joy Feka ◽  
Lisa Gensthaler ◽  
Ivan Kristo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Postoperative Morbidity ◽  
Gastrointestinal Symptoms ◽  
Postoperative Outcome ◽  
Magnetic Sphincter Augmentation ◽  
Comparable Group ◽  
Significant Difference ◽  
Related Quality

Abstract Background Magnetic sphincter augmentation (MSA) is a modern surgical anti-reflux technique with proven efficacy and low postoperative morbidity in patients with acidic reflux. The aim of this retrospective review study was to evaluate the symptomatic outcome of MSA in patients with weakly acidic reflux. Methods From a prospectively collected clinical database, comprising all 327 patients that underwent MSA at our institution, a total of 67 patients with preoperative weakly acidic reflux measured in the 24-h impedance-pH-metry were identified. Postoperative gastrointestinal symptoms, proton pump inhibitor intake (PPI), GERD Health-Related Quality-of-Life (GERD-HRQL), alimentary satisfaction (AS), and patients’ overall satisfaction were evaluated within highly standardized follow-up appointments. Furthermore, outcome of these patients was compared to the postoperative outcome of a comparable group of patients with a preoperative acidic reflux. Results At a median follow-up of 24 months, none of the patients with weakly acidic reflux presented with persistent dysphagia, or underwent endoscopic dilatation or reoperation. The postoperative GERD-HRQL score was significantly reduced (2 vs. 20; p = 0.001) and the median AS was 9/10. Preoperative daily heartburn, regurgitations, and respiratory complaints were improved in 95%, 95%, and 96% of patients, respectively. A total of 10% of the patients continued to use PPIs postoperatively. No significant difference was observed in terms of postoperative outcome or quality of life when comparing weakly acidic reflux patients with those diagnosed with preoperative acidic reflux. Conclusion Magnetic sphincter augmentation significantly improves GERD-related symptoms and quality of life in patients with weakly acidic reflux with very low postoperative morbidity.

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