A possible endoscopic therapy for large hiatal hernia complicated with refractory gastroesophageal reflux disease

Abstract INTRODUCTION Laparoscopic Fundoplication (LF) as a treatment for gastroesophageal reflux disease (GERD) has positive clinical outcomes. However, postoperative dysphagia (PD) may appear as a side effect. Our objective is to analyze PD in patients operated on for LF in our center. MATERIAL AND METHODS Retrospective and descriptive study of patients operated on for GERD from September 1997 to February 2019. RESULTS 248 patients (60.5% men), with a mean age of 49.7 (21-82), were operated. 66.1% of the patients presented associated comorbidities, highlighting obesity (19.8%). 75% manifested typical symptoms, 19% presenting with Barrett’s esophagus. Sliding hiatal, paraesophageal, mixed and complex hernia were diagnosed in 151 (60.9%), 23 (9.3%), 12 (4.8%), and 4 (1.6%) patients, respectively. The LF Nissen was the most frequent technique (91.5%), using a caliper in 46% of the cases. PD was the most frequent symptom, present in 57 (23%) patients. It was resolved with dilation in 9 patients, requiring 6 patients surgical reintervention. In those PD cases, a caliper was used in 28 (49.1%) patients, without finding significant differences between them (P = .586). Nor were there significant differences between PD and obesity (P = .510), type of hiatal hernia (P = .326), or surgical technique (P = .428). After a median follow-up of 50.5 months, quality of life was classified as Visick I-II, III, and IV in 76.6%, 6.9% and 1.2% of the cases, respectively. CONCLUSION No association between PD and the use of calipers, surgical technique or type of hiatal hernia was found in our series.

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Comment on: The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2013.11.012 ◽

2014 ◽

Vol 10 (2) ◽

pp. 255-256

Author(s):

Zhamak Khorgami ◽

Chi Zhang ◽

Nestor de la Cruz-Muñoz

Keyword(s):

Sleeve Gastrectomy ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hernia Repair ◽

Laparoscopic Sleeve Gastrectomy ◽

Hiatal Hernia ◽

Reflux Disease ◽

Hiatal Hernia Repair ◽

Obese Patients

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Endoscopic therapy for gastroesophageal reflux disease

Gastrointestinal Endoscopy Clinics of North America ◽

10.1016/s1052-5157(03)00002-3 ◽

2003 ◽

Vol 13 (1) ◽

pp. xvii-xix

Author(s):

Richard I. Rothstein

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Endoscopic Therapy

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SHORT-TERM RESULTS OF MINIMALLY INVASIVE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE BY RADIOFREQUENCY (STRETTA): FIRST BRAZILIAN SERIES OF CASES

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-51 ◽

2018 ◽

Vol 55 (suppl 1) ◽

pp. 52-55 ◽

Cited By ~ 1

Author(s):

Thiago Ferreira de SOUZA ◽

Eduardo GRECCO ◽

Luiz Gustavo de QUADROS ◽

Yael Duarte de ALBUQUERQUE ◽

Fernanda Oliveira AZÔR ◽

...

Keyword(s):

Surgical Treatment ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Minimally Invasive ◽

Treatment Failure ◽

Reflux Disease ◽

Endoscopic Therapy ◽

Symptom Control ◽

Short Term ◽

Invasive Treatment

ABSTRACT BACKGROUND: New endoscopic treatments for gastroesophageal reflux (GERD) are developed every year and are indicated in cases that are refractory to conventional therapies as well as after surgical treatment failure. OBJECTIVE: To present the first cases of endoscopic therapy for GERD performed in Brazil. METHODS: Use of radiofrequency with the Stretta procedure in symptomatic volunteers diagnosed with GERD. RESULTS The technique was performed in three patients after they were included in the study protocol. No patient had complications, and all patients were discharged on the same day, either without medication or taking it sporadically for symptom control. CONCLUSION: Endoscopic treatment for GERD using radiofrequency was effective in the cases presented herein with no technical complications.

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Reply to “Comment on: The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients”

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2013.12.002 ◽

2014 ◽

Vol 10 (2) ◽

pp. 371-372 ◽

Cited By ~ 2

Author(s):

Antonella Santonicola ◽

Luigi Angrisani ◽

Paola Iovino

Keyword(s):

Sleeve Gastrectomy ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hernia Repair ◽

Laparoscopic Sleeve Gastrectomy ◽

Hiatal Hernia ◽

Reflux Disease ◽

Hiatal Hernia Repair ◽

Obese Patients

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677 ROBOTIC-ASSISTED HIATAL HERNIA AND GASTROESOPHAGEAL REFLUX DISEASE RE-DO SURGERY: A SINGLE INSTITUTION EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doab052.677 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Arantxa Clavell Font ◽

Sara Senti Farrarons ◽

Marta Viciano Martin ◽

Elisenda Garsot Savall

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hiatal Hernia ◽

Reflux Disease ◽

Hernia Recurrence ◽

Complication Rates ◽

Robotic Approach ◽

Clinical Recurrence ◽

The Mean ◽

Hiatal Hernia Recurrence

Abstract Hiatal hernia recurrence (HHR) after surgical repair associated with dysphagia, gastroesophageal reflux disease or other symptoms represents a non-negligible disease that frequently needs a reoperative solution. The repair of a relapsed hiatal hernia represents a surgical challenge due to anatomic changes and fibrosis, and the robotic approach seems to provide benefits because offers enhanced visualization and dexterity. Methods Between June 2019 and February 2021, 7 patients (1 male, 6 female) underwent redo robotic approach surgery for hiatal hernia recurrence after being pre operative diagnosed. All surgeries were elective and all patients had both clinical and radiologic recurrence. Biosynthetic tissue absorbable mesh was applied in one patient with double time recurrence hernia. Four patients underwent total fundoplication (Nissen), 2 patients had Toupet fundoplication, and one patient had hiatus repair without fundoplication. Results The mean age of the patients was 62.7 years and the main expressed symptom for the patient was dysphagia. Time to clinical recurrence was 13 months. Biosynthetic mesh was used in one patient. The mean operative time was 143 minutes (80–240) and no intraoperative complications were described. There were no conversions to open or laparoscopic procedures. The early and 30 day mortality rate was 0% and mean hospital stay was 2.7 days. Conclusion Robotic support, when available, can be beneficial in redo surgery for GERD and hiatal hernia recurrence. Despite our short experience, we believe the robotic approach for redo hiatal surgery is safe and effective with low complication rates even in high-risk patients.

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