The Outcomes of Performing Partial Fundoplication Based on Endoflip Versus Manometric Findings

The American Surgeon ◽

10.1177/00031348211054565 ◽

2021 ◽

pp. 000313482110545

Author(s):

Medhat Fanous ◽

Wei Wei

Keyword(s):

Hiatal Hernia ◽

Antireflux Surgery ◽

Esophagogastric Junction ◽

Surgical Techniques ◽

Hiatal Hernia Repair ◽

Partial Fundoplication ◽

Laparoscopic Hiatal Hernia Repair ◽

Significant Difference ◽

American Society ◽

Gerd Symptoms

Background The surgical management of gastroesophageal reflux disease (GERD) involves extensive diagnostic studies and sophisticated surgical techniques. The workup should be comprehensive and purposeful. High resolution impedance manometry (HRIM) provides valuable information regarding peristalsis and lower esophageal sphincter relaxation. The disadvantages of HRIM such as intolerance or inability to pass the catheter led to its selective use or even omission especially in laparoscopic hiatal hernia repair with partial fundoplication. This pragmatic approach risks missing motility disorders in patients with secondary reflux symptoms related to achalasia or scleroderma. Endolumenal functional lumen imaging probe (endoFLIP) can fill this void as it evaluates the dynamics of the esophagogastric junction under sedation. This study aims to compare the outcomes of preoperative use of HRIM vs endoFLIP for laparoscopic repair of hiatal hernia with partial fundoplication. Methods This is a retrospective cohort study for consecutive patients who underwent antireflux surgery with partial fundoplication between July 2018 and February 2021. Preoperative and postoperative outcomes were compared between two cohorts of patients: those with preoperative HRIM and those with preoperative endoFLIP. Results A total of 72 patients were evaluated, 41 had preoperative HRIM and 31 had endoFLIP. There was no statistically significant difference in their age, sex, BMI, duration of GERD symptoms, or proton pump inhibitors use. The endoscopic findings of esophagitis, hiatal hernia, and Hill’s grade were comparable. There was no difference in the American Society of Anesthesiology classification or the choice of antireflux surgery. The improvement of postoperative GERD scores and dysphagia subscore was similar between the two groups. Conclusion Performing partial fundoplication based on endoFLIP evaluation of the dynamics of the esophagogastric junction is safe and does not increase postoperative dysphagia compared to preoperative manometric use. Randomized prospective studies are needed to confirm the findings of this study.

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Age-related outcomes in laparoscopic hiatal hernia repair: Is there a “too old” for antireflux surgery?

Surgical Endoscopy ◽

10.1007/s00464-020-07489-5 ◽

2020 ◽

Vol 35 (1) ◽

pp. 429-436 ◽

Cited By ~ 2

Author(s):

Alex Addo ◽

Zachary Sanford ◽

Andrew Broda ◽

H. Reza Zahiri ◽

Adrian Park

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Antireflux Surgery ◽

Hiatal Hernia Repair ◽

Age Related ◽

Laparoscopic Hiatal Hernia Repair

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

Hirurg (Surgeon) ◽

10.33920/med-15-2001-01 ◽

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.

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Laparoscopic hiatal hernia repair: why they fail

Hernia ◽

10.1007/bf01201070 ◽

2000 ◽

Vol 4 (4) ◽

pp. 219-222 ◽

Cited By ~ 3

Author(s):

C. J. Filipi

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Hiatal Hernia Repair ◽

Laparoscopic Hiatal Hernia Repair

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

Acta Medica Leopoliensia ◽

10.25040/aml2020.04.050 ◽

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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Iatrogenic cardiac tamponade after laparoscopic hiatal hernia repair requiring emergency sternotomy

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy433 ◽

2018 ◽

Vol 56 (1) ◽

pp. 215-215 ◽

Cited By ~ 1

Author(s):

Samuel Heuts ◽

Walther N K A van Mook ◽

Eric J Belgers ◽

Roberto Lorusso

Keyword(s):

Hernia Repair ◽

Cardiac Tamponade ◽

Hiatal Hernia ◽

Hiatal Hernia Repair ◽

Laparoscopic Hiatal Hernia Repair

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

Diseases of the Esophagus ◽

10.1093/dote/doab052.532 ◽

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 (>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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