Surgical treatment of hiatal hernia: A ten-year experience

Background/Aim. Today, hiatal hernia and the accompanying gastroesophageal reflux disease (GERD) are the most common benign disorders of the upper gastrointestinal tract. The aim of this study was to present the results of the hiatal hernia and GERD laparoscopic surgery in finding out for best type of fundoplication in each individual case. Methods. The study included 132 patients with the diagnosis of hiatal hernia and GERD, operated in the period from May 2004 to December 2014 at the Clinic for Abdominal, Endocrine and Transplantation Surgery of the Clinical Center Vojvodina, Serbia. The patients were selected for surgery on the basis of the findings of esophago-gastroscopy, barium contrast upper gastrointestinal series, 24-hour pH monitoring and esophageal manometric studies. Results. All the patients in this series underwent a posterior hiatoplasty with direct sutures. An additional mesh reinforcement was performed in 21 (16%) patients with a large hiatal hernia. There were 68 Nissen, 59 Toupet, and 5 Door fundoplications. Recently, the short-floppy Nissen fundoplication has predominantly been performed due to good postoperative outcomes. Intraoperative complications were: the parietal pleura lesion (3 patients), the spleen capsule laceration (4 patients), a minor injury of the adventitia of the distal esophagus (1 patient) and a thermal injury of the gastric fundus (1 patient). The postoperative complications were as folows: one fistula of the gastric fundus, transitory subcutaneous emphysema in the neck (5 patients), minor left-sided pleural effusions (6 patients), a transitory dysphagia (23 patients). The overall recurrence rate was 18.2% (24 patients). There was one fatal outcome. Conclusion. Laparoscopic surgery is considered a safe and effective surgical procedure for the treatment of hiatal hernia. The hiatal repair with a mesh reinforcement is recommended in selected cases. Today all consider the ?short floppy? Nissen fundoplication as procedure of choice for the adequate hiatal repair.

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LINX: How I Do It and Why

Foregut: The Journal of the American Foregut Society ◽

10.1177/26345161211026329 ◽

2021 ◽

pp. 263451612110263

Author(s):

Reginald C.W. Bell

Keyword(s):

Laparoscopic Surgery ◽

Minimally Invasive ◽

Magnetic Beads ◽

Nissen Fundoplication ◽

Magnetic Sphincter Augmentation ◽

First Line ◽

Esophageal Dissection ◽

Laparoscopic Nissen ◽

Hernia Size ◽

Hiatal Repair

The LINX device consists of a “bracelet” of magnetic beads in titanium cases, connected by individual wires placed noncompressively around the distal esophagus during laparoscopic surgery. This augments the native lower esophageal sphincter’s (LES) ability to resist reflux by increasing yield pressure and resisting shortening of the LES. Magnetic sphincter augmentation (MSA) was conceived as a safe, stomach sparing, minimally invasive, reversible implantable device for patients seeking an alternative to laparoscopic Nissen fundoplication. Though initially studied in patients with limited hiatal hernias, its use has expanded to include patients with large and even giant or paraesophageal hernias with excellent results. The author’s techniques of complete esophageal dissection, precise hiatal repair, current concepts on noncompressive sizing and placement of the MSA device are reviewed in this article. MSA can be considered first-line surgical therapy for GERD patients with adequate peristalsis regardless of hernia size.

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Robot-assisted vs. laparoscopic repair of complete upside-down stomach hiatal hernia (the RATHER-study): A prospective comparative single center study

British Journal of Surgery ◽

10.1093/bjs/znab202.001 ◽

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.

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ANALYSIS OF EARLY POST-OPERATIONAL COMPLICATIONS IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERY FOR HIATAL HERNIA

Clinical Practice ◽

10.17816/clinpract8146-49 ◽

2017 ◽

Vol 8 (1) ◽

pp. 46-49

Author(s):

M A Burikov ◽

O V Shoolgin ◽

I V Skazkin ◽

A I Kinyakin ◽

I A Sokirenko

Keyword(s):

Laparoscopic Surgery ◽

Postoperative Complications ◽

Hiatal Hernia ◽

Postoperative Period ◽

Nissen Fundoplication ◽

Biological Prosthesis ◽

Early Postoperative Complications ◽

Hiatal Closure ◽

Prosthetic Reinforcement

In order to identify the advantages of the original modification of Nissen fundoplication techniques and identify the safest mash material for prosthetic reinforcement of hiatal closure, was made analysis of early postoperative complications in 121 patients with hiatal hernia.The formation of the non tension fundoplication reduces the level of early postoperative complications. The usage of biological prosthesis has the advantage in comparison with synthetic ones. In general, the usage of mashes significantly increases the severity of the complaints of patients after the intervention, but most of them are within 3-14 days of the postoperative period.

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A CASE OF RECURRENT HIATAL HERNIA AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION WITH SUCCESSFUL LAPAROSCOPIC SURGERY

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.67.602 ◽

2006 ◽

Vol 67 (3) ◽

pp. 602-605 ◽

Cited By ~ 1

Author(s):

Nobuo OMURA ◽

Hideyuki KASHIWAGI ◽

Yoshio ISHIBASHI ◽

Fumiaki YANO ◽

Kazuto TSUBOI ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Hiatal Hernia ◽

Nissen Fundoplication ◽

Laparoscopic Nissen Fundoplication ◽

Laparoscopic Nissen ◽

Recurrent Hiatal Hernia

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Paraesophageal Hiatal Hernia with Upside-Down Stomach Treated by Laparoscopic Surgery

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.68.46 ◽

2017 ◽

Vol 68 (1) ◽

pp. 46-51

Author(s):

Kazutaka Kadoya ◽

Toshiaki Tanaka ◽

Satoru Matono ◽

Naoki Mori ◽

Haruhiro Hino ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Hiatal Hernia ◽

Paraesophageal Hiatal Hernia

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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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Two cases of intraoperative hemodynamic instability during combined thoracoscopic-laparoscopic surgery for esophagogastric junction carcinoma

JA Clinical Reports ◽

10.1186/s40981-021-00419-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Makiko Tani ◽

Yoshikazu Matsuoka ◽

Mayu Sugihara ◽

Ayaka Fujii ◽

Tomoyuki Kanazawa ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Esophagogastric Junction ◽

Intraoperative Complications ◽

Proximal Gastrectomy ◽

Tension Pneumothorax ◽

Hemodynamic Instability ◽

Laparoscopic Proximal Gastrectomy ◽

Surgical Field ◽

Coronary Ischemia ◽

Thoracic And Abdominal

Abstract Background Intraoperative complications during combined thoracoscopic-laparoscopic surgery for esophagogastric junction (EGJ) carcinoma have not been reported as compared to those during surgery for esophageal carcinoma. We present two cases which had surgery-related hemodynamic instability during laparoscopic proximal gastrectomy and intra-mediastinal valvuloplastic esophagogastrostomy (vEG) with thoracoscopic mediastinal lymphadenectomy for EGJ carcinoma. Case presentation In case 1, the patient fell into hypotension with hypoxemia during laparoscopic vEG due to pneumothorax caused by entry of intraabdominal carbon dioxide. In case 2, ventricular arrythmia and ST elevation occurred during laparoscopic vEG. Pericardium retraction to secure surgical field during reconstruction compressed the coronary artery, which caused coronary malperfusion. These two events were induced by the surgical procedure, characterized by the following: (1) connection of the thoracic and abdominal cavities and (2) cardiac displacement during vEG. Conclusion These cases indicated tension pneumothorax and coronary ischemia are possible intraoperative complications specific to combined thoracoscopic-laparoscopic surgery for EGJ carcinoma.

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Severe Referred Shoulder Pain Following Revision Fundoplication From a Stich on the Diaphragm

The American Surgeon ◽

10.1177/00031348211011110 ◽

2021 ◽

pp. 000313482110111

Author(s):

Kevin J. Gale ◽

Santana Sanchez ◽

Thomas J. Sorenson ◽

Todd D. Elftmann

Keyword(s):

Hiatal Hernia ◽

Shoulder Pain ◽

Medical Management ◽

Nissen Fundoplication ◽

Left Shoulder ◽

Toupet Fundoplication

Complications following fundoplication surgery for hiatal hernias are rare. Herein, we present the case of a 61-year-old woman who underwent a Nissen fundoplication, complicated by dysphagia, and a revision modified Toupet fundoplication for a hiatal hernia, after which she began to experience severe prandial referred left shoulder pain that was refractory to medical management. We hypothesized that a diaphragmatic suture placed during the revision fundoplication could be the source of the pain, and we elected to remove the suture, resulting in resolution of the pain. This pain remained resolved at the most recent follow-up on postoperative week six, and the patient had no further concerns.

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