Symptom Relief After Laparoscopic Paraesophageal Hernia Repair Without Mesh

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2015 Aug 6

PMID 26242885

Citations 8

Authors

Rym El Khoury

Mauricio Ramirez

Eric S Hungness

Nathaniel J Soper

Marco G Patti

Affiliations

Soon will be listed here.

Abstract

Background: Laparoscopic repair of paraesophageal hernia (LPEHR) is considered today the standard of care for this condition. While attention has been mostly focused on the incidence of postoperative radiologic recurrence of a hiatal hernia, few data are available about the effect of the operation on symptoms.

Aims: In this study, we aim to determine the effect of primary LPEHR on postoperative symptoms.

Patients And Methods: One hundred and sixty-two patients underwent LPEH repair in two academic tertiary care centers. Preoperative evaluation included barium swallow (100 %), endoscopy (80 %), manometry (81 %), and pH monitoring (25 %). Type III PEH was the most common (94 %), and it was associated with a gastric volvulus in 27 % of patients.

Results: A fundoplication was performed in all patients: Nissen in 57 %, Dor in 36 %, and Toupet in 6 %. A Collis gastroplasty was added in 6 % of patients. There were no perioperative deaths. The intraoperative complication rate was 7 %. The operation was completed laparoscopically in 98 % of patients. Postoperative complications occurred in four patients, and three needed a second operation. Average follow-up was 24 months. Heartburn, regurgitation, chest pain, dysphagia, respiratory symptoms, and hoarseness improved as a result of the operation. Anemia fully resolved in all patients.

Conclusions: LPEH repair is safe and effective, and the need for reoperation is rare. Few patients experience postoperative symptoms, and these are easily controlled with acid-reducing medications.

Citing Articles

EAES Multidisciplinary Rapid Guideline: systematic review, meta-analysis, GRADE assessment and evidence-informed recommendations on the surgical management of paraesophageal hernias.

Markar S, Menon N, Guidozzi N, Kontouli K, Mavridis D, Andreou A Surg Endosc. 2023; 37(12):9013-9029.

PMID: 37910246 DOI: 10.1007/s00464-023-10511-1.

Paraesophageal hernia: to fundoplicate or not?.

Solomon D, Bekhor E, Kashtan H Ann Transl Med. 2021; 9(10):902.

PMID: 34164536 PMC: 8184421. DOI: 10.21037/atm.2020.03.106.

Hiatal hernia prevalence and natural history on non-contrast CT in the Multi-Ethnic Study of Atherosclerosis (MESA).

Kim J, Hiura G, Oelsner E, Yin X, Barr R, Smith B BMJ Open Gastroenterol. 2021; 8(1).

PMID: 33731384 PMC: 7978087. DOI: 10.1136/bmjgast-2020-000565.

Paraesophageal hernia repair: a curative consideration for chronic anemia?.

Cheverie J, Lam J, Neki K, Broderick R, Lee A, Matsuzaki T Surg Endosc. 2019; 34(5):2243-2247.

PMID: 31346751 DOI: 10.1007/s00464-019-07014-3.

Long-Term Outcomes Following Laparoscopic Repair of Large Hiatus Hernias Performed by Trainees Versus Consultant Surgeons.

Parker D, Bright T, Irvine T, Thompson S, Watson D J Gastrointest Surg. 2019; 24(4):749-755.

PMID: 31012041 DOI: 10.1007/s11605-019-04218-9.

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