Thinking About Hiatal Hernia Recurrence After Laparoscopic Repair: When Should It Be Considered a True Recurrence? A Different Point of View

Background: High rates of recurrence after laparoscopic hiatal hernia repair have been published. Most of these recurrences are asymptomatic and only diagnosed by endoscopic or radiologic studies. The definition of hiatal hernia recurrence is still under discussion. Objective: This study aimed to define a true hiatal hernia recurrence using a score and classification criteria considering the presence of symptoms and size of the recurrence. Patients and Methods: A total of 153 patients with giant hiatal hernia larger than 10 cm in diameter underwent an operation using a laparoscopic approach. Of these patients, 129 had a complete follow-up (3–5 years) after surgery, and they were the only ones included in this study. The IT system of our hospital was our database for data registration. A score and classification were designed for definition of a “true” hiatal hernia recurrence, based on postoperative symptoms and the presence or not of a hiatal hernia in both radiologic and endoscopic evaluations. Results: Hiatal hernia recurrence based on endoscopic and/or radiologic hiatal hernia was found in 55 patients (42.6%), and only 28 of them (50.9%) had recurrent symptoms. Applying the score and proposed classification, no recurrence was considered in 18 patients (13.9%). Symptomatic and true recurrence were considered in 22.9% of patients (29 patients). Reoperation was needed for 7 patients (5.4%) because of symptomatic and radiologic recurrence. Conclusions: Postoperative symptoms, endoscopic findings, or radiologic findings are important for the definition of the type of recurrence and for the indication of appropriate treatment. The proposed score and classification are useful in order to specify the hiatal hernia recurrence and treatment.

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791 RECURRENT HIATAL HERNIA A HIGH PREDICTOR OF PATHOLOGIC REFLUX AND NEED FOR REINTERVENTION

Diseases of the Esophagus ◽

10.1093/dote/doab052.791 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Jacques Greenberg ◽

Fernando Valle Reyes ◽

Blake Christianson ◽

Daniel Margolis ◽

Jessica Thiesmeyer ◽

...

Keyword(s):

Hiatal Hernia ◽

Hernia Recurrence ◽

Hiatal Hernia Repair ◽

Recurrence Rates ◽

Mesh Augmentation ◽

True Recurrence ◽

Barium Esophagram ◽

Hiatal Hernia Recurrence ◽

Hernia Size

Abstract Anti-reflux surgery (ARS) has been postulated to have high failure rates, which may approach 50% depending upon hiatal hernia size. Most failures are thought to be related to wrap disruption or hiatal hernia recurrence. Recently, diaphragmatic mesh augmentation has been shown to reduce hiatal hernia recurrence. We aimed to determine factors that influence recurrence based on vigilant imaging and diagnostic pH studies, and the need for surgical reintervention. Methods A prospectively maintained database of all patients undergoing index robotic ARS (including Hill, Nissen, Toupet, and Linx procedures) with Phasix ST ® mesh was queried. Between December 2016 and July 2020, 134 patients were identified of which 92 met inclusion criteria for post-operative barium esophagram performed at routine intervals (6, 12, or 24-months) or for recurrent symptoms. Median follow-up time was 11.4 months. Clinical characteristics, manometry, pH studies, as well as surgical approach was evaluated. Radiographic recurrences were then associated with endoscopic confirmation and rates of surgical re-intervention. Results Radiographic recurrence >2 cm was noted in 9 (9.8%) patients, of which 44% were symptomatic, compared to 36% of those without radiographic recurrence (p = 0.620). Endoscopy confirmed recurrence in 67% of patients with radiographic recurrence versus 0% without (p = 0.001). When all radiographic recurrences, including those <2 cm, were evaluated, 17 (18%) were identified, of which 53% of patients were symptomatic. Endoscopic and pH studies confirmed recurrences in 75% and 71% of these patients, respectively. Overall reintervention rates were 23% in the setting of any radiographic recurrence versus 1.3% without (p = 0.001). Conclusion Recurrence rates following robotic ARS and hiatal hernia repair with mesh augmentation appear low with nearly 1-year follow-up. Prior to surgical reintervention, endoscopic and pH studies are warranted to confirm symptomatic recurrence. Recurrent hiatal hernias, including those <2 cm, can lead to abnormal pH studies that merit reintervention at rates higher than those without evidence of recurrence. Longer term follow-up is required to optimally delineate true recurrence patterns.

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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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Predictors of Hiatal Hernia Recurrence after Laparoscopic Anti-Reflux Surgery with Hiatal Hernia Repair: A Prospectively Collected Database Analysis

Gastroenterology ◽

10.1016/s0016-5085(17)34128-8 ◽

2017 ◽

Vol 152 (5) ◽

pp. S1241

Author(s):

Priscila R. Armijo ◽

Spyridon Pagkratis ◽

Dmitry Oleynikov

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Hernia Recurrence ◽

Hiatal Hernia Repair ◽

Database Analysis ◽

Hiatal Hernia Recurrence

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Predictors of Hiatal Hernia Recurrence After Laparoscopic Anti-reflux Surgery with Hiatal Hernia Repair: a Prospective Database Analysis

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-018-04073-0 ◽

2019 ◽

Vol 23 (4) ◽

pp. 696-701 ◽

Cited By ~ 8

Author(s):

Priscila R. Armijo ◽

Bhavani Pokala ◽

Mitchel Misfeldt ◽

Spyridon Pagkratis ◽

Dmitry Oleynikov

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Hernia Recurrence ◽

Hiatal Hernia Repair ◽

Database Analysis ◽

Hiatal Hernia Recurrence ◽

Prospective Database

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Hiatal Hernia Repair with Gore Bio-A Tissue Reinforcement: Our Experience

Case Reports in Surgery ◽

10.1155/2014/851278 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Agrusa Antonino ◽

Romano Giorgio ◽

Frazzetta Giuseppe ◽

De Vita Giovanni ◽

Di Giovanni Silvia ◽

...

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Laparoscopic Approach ◽

Acid Reflux ◽

Hiatal Hernia Repair ◽

Type I ◽

Absorbable Mesh ◽

Laparoscopic Hiatal Hernia Repair ◽

Crural Closure ◽

History Of

Type I hiatal hernia is associated with gastroesophageal reflux disease (GERD) in 50–90% of cases. Several trials strongly support surgery as an effective alternative to medical therapy. Today, laparoscopic fundoplication is considered as the procedure of choice. However, primary laparoscopic hiatal hernia repair is associated with upto 42% recurrence rate. Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones. We experiment a new totally absorbable mesh by Gore.Case. We present a case of a 65-year-old female patient with a 6-year classic history of GERD. Endoscopy revealed a large hiatal hernia and esophagitis. pH study was positive for acid reflux; esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic approach, the hiatal hernia defect was identified and primarily repaired, by crural closure. Gore Bio-A Tissue Reinforcement was trimmed to fit the defect accommodating the esophagus. Nissen fundoplication was performed.Result. Bio-A mesh was easily placed laparoscopically. It has good handling and could be cut and tailored intraoperatively for optimal adaptation. There were no short-term complications.Conclusion. Crural closure reinforcement can be done readily with this new totally absorbable mesh replaced by soft tissue over six months. However, further data and studies are needed to evaluate long-term outcomes.

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