Laparoscopic Repair of Paraesophageal Hernia with Anterior Gastropexy: a Multicenter Study

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2014 Oct 9

PMID 25294550

Citations 15

Authors

Christopher R Daigle

Peter Funch-Jensen

Dan Calatayud

Peter Rask

Bo Jacobsen

Teodor P Grantcharov

Affiliations

Soon will be listed here.

Abstract

Background: The approach to repair of paraesophageal hernias (PEHs) is controversial. Recent data suggest that mesh repair leads to recurrence rates similar to non-mesh approaches, while subjecting patients to mesh-associated complications. Routine fundoplication during PEH repair has been favored despite significant dysphagia rates. We present our multicenter prospective data on laparoscopic PEH repairs using a modified Boerema anterior gastropexy without fundoplication.

Methods: We prospectively followed patients after modified Boerema PEH repair at three institutions. Patient demographics, perioperative data, and postoperative outcomes were evaluated. Subjective and objective outcomes were assessed via clinical assessment, follow-up questioning, endoscopy, and radiographic swallow studies.

Results: A total of 101 patients were followed a mean of 10.8 (median, 12) months. We encountered 9 (8.9%) intraoperative complications and 13 (12.9%) postoperative complications. There was no mortality. Reflux symptoms were absent in 71 patients (70.3%) postoperatively. Of the remaining subjects, 8 (7.9%) had mild intermittent reflux without the need for proton pump inhibitors (PPI), 12 (11.9%) had moderate reflux necessitating PPI as needed, and 10 (9.9%) had reflux requiring daily PPI. Our recurrence rate, assessed at postoperative endoscopy/barium swallow, was 16.8%. Of these, 10 (9.9%) were small segmental recurrences and 7 (6.9%) were large recurrences.

Conclusion: Herein, we demonstrate a favorable recurrence rate while avoiding the potential major complications associated with mesh hiatoplasty. Our data tend to support a tailored approach to incorporation of fundoplication during PEH repair. Postoperative acid reflux was absent in most of our patients, and pharmacotherapy alone was sufficient for those experiencing reflux symptoms.

Citing Articles

Functional results after hiatal repair and gastropexy without fundoplication in patients with paraoesophageal hernia.

Bomio-Pacciorini L, Gaspar-Figueiredo S, Mantziari S, Godat S, Schafer M, Farinha H Langenbecks Arch Surg. 2024; 409(1):150.

PMID: 38702556 PMC: 11068662. DOI: 10.1007/s00423-024-03340-w.

The role of anterior gastropexy in elderly Japanese hiatal hernia patients.

Yokouchi T, Nakajima K, Takahashi T, Yamashita K, Saito T, Tanaka K Surg Today. 2024; 54(9):1051-1057.

PMID: 38514475 DOI: 10.1007/s00595-024-02809-x.

Gastric necrosis secondary to gastric volvulus in a paraesophageal hernia: a case report.

Bolliet M, Katuwal B, Kolachalam R J Surg Case Rep. 2024; 2024(2):rjae072.

PMID: 38370586 PMC: 10871761. DOI: 10.1093/jscr/rjae072.

Emergency surgery for hiatus hernias: does technique affect outcomes? A single-centre experience.

Alasmar M, McKechnie I, Chaparala R Updates Surg. 2023; 75(5):1227-1233.

PMID: 36869223 PMC: 10359210. DOI: 10.1007/s13304-023-01482-y.

Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis.

Clapp B, Kara A, Nguyen-Lee P, Annabi H, Alvarado L, Marr J Surg Endosc. 2022; 37(3):2295-2303.

PMID: 35951120 DOI: 10.1007/s00464-022-09514-1.

References

Watson D . Evolution and development of surgery for large paraesophageal hiatus hernia. World J Surg. 2011; 35(7):1436-41. DOI: 10.1007/s00268-011-1029-3. View

ELLIS Jr F, CROZIER R, Shea J . Paraesophageal hiatus hernia. Arch Surg. 1986; 121(4):416-20. DOI: 10.1001/archsurg.1986.01400040052007. View

Broeders J, Sportel I, Jamieson G, Nijjar R, Granchi N, Myers J . Impact of ineffective oesophageal motility and wrap type on dysphagia after laparoscopic fundoplication. Br J Surg. 2011; 98(10):1414-21. DOI: 10.1002/bjs.7573. View

Poncet G, Robert M, Roman S, Boulez J . Laparoscopic repair of large hiatal hernia without prosthetic reinforcement: late results and relevance of anterior gastropexy. J Gastrointest Surg. 2010; 14(12):1910-6. DOI: 10.1007/s11605-010-1308-6. View

Walther B, DeMeester T, LAFONTAINE E, Courtney J, Little A, SKINNER D . Effect of paraesophageal hernia on sphincter function and its implication on surgical therapy. Am J Surg. 1984; 147(1):111-6. DOI: 10.1016/0002-9610(84)90043-6. View

Gordon C, Kang J, Neild P, Maxwell J . The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2004; 20(7):719-32. DOI: 10.1111/j.1365-2036.2004.02149.x. View

Ponsky J, Rosen M, Fanning A, Malm J . Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair. Surg Endosc. 2003; 17(7):1036-41. DOI: 10.1007/s00464-002-8765-2. View

Rakic S, Pesko P, Dunjic M, Gerzic Z . Paraoesophageal hernia repair with and without concomitant fundoplication. Br J Surg. 1994; 81(8):1162-3. DOI: 10.1002/bjs.1800810826. View

Cuomo R, Grasso R, Sarnelli G, Bruzzese D, Bottiglieri M, Alfieri M . Role of diaphragmatic crura and lower esophageal sphincter in gastroesophageal reflux disease: manometric and pH-metric study of small hiatal hernia. Dig Dis Sci. 2002; 46(12):2687-94. DOI: 10.1023/a:1012723412257. View

10.

Hyun J, Bak Y . Clinical significance of hiatal hernia. Gut Liver. 2011; 5(3):267-77. PMC: 3166665. DOI: 10.5009/gnl.2011.5.3.267. View

11.

Casabella F, Sinanan M, Horgan S, Pellegrini C . Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg. 1996; 171(5):485-9. DOI: 10.1016/S0002-9610(97)89609-2. View

12.

Oelschlager B, Pellegrini C, Hunter J, Brunt M, Soper N, Sheppard B . Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg. 2011; 213(4):461-8. DOI: 10.1016/j.jamcollsurg.2011.05.017. View

13.

Geha A, Massad M, Snow N, Baue A . A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery. 2000; 128(4):623-30. DOI: 10.1067/msy.2000.108425. View

14.

BOEREMA W . Anterior gastropexy: a simple operation for hiatus hernia. Aust N Z J Surg. 1969; 39(2):173-5. DOI: 10.1111/j.1445-2197.1969.tb05582.x. View

15.

Triponez F, Dumonceau J, Azagury D, Volonte F, Slim K, Mermillod B . Reflux, dysphagia, and gas bloat after laparoscopic fundoplication in patients with incidentally discovered hiatal hernia and in a control group. Surgery. 2005; 137(2):235-42. DOI: 10.1016/j.surg.2004.07.016. View

16.

Stadlhuber R, Sherif A, Mittal S, Fitzgibbons Jr R, Brunt L, Hunter J . Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2008; 23(6):1219-26. DOI: 10.1007/s00464-008-0205-5. View

17.

Tatum R, Shalhub S, Oelschlager B, Pellegrini C . Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg. 2007; 12(5):953-7. DOI: 10.1007/s11605-007-0316-7. View

18.

Watson D, de Beaux A . Complications of laparoscopic antireflux surgery. Surg Endosc. 2001; 15(4):344-52. DOI: 10.1007/s004640000346. View

19.

Zugel N, Lang R, Kox M, Huttl T . Severe complication of laparoscopic mesh hiatoplasty for paraesophageal hernia. Surg Endosc. 2009; 23(11):2563-7. DOI: 10.1007/s00464-009-0456-9. View

20.

Agwunobi A, Bancewicz J, Attwood S . Simple laparoscopic gastropexy as the initial treatment of paraoesophageal hiatal hernia. Br J Surg. 1998; 85(5):604-6. DOI: 10.1046/j.1365-2168.1998.00639.x. View