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Fundic gastropexy for high risk of recurrence laparoscopic hiatal hernia repair and esophageal sphincter augmentation (LINX) improves outcomes without altering perioperative course

  • 2020 SAGES Poster
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Abstract

Background

The aim of this study is to show that the addition of a fundic gastropexy to a laparoscopic hiatal hernia repair (HHR) and magnetic sphincter augmentation (MSA) with LINX (Johnson and Johnson, New Brunswick, NJ) in patients with high risk for hiatal hernia recurrence improves outcomes without altering perioperative course.

Methods

An IRB approved, single institution retrospective review of patient outcomes after hiatal hernia repair with magnetic sphincter augmentation was performed. Data were obtained from the electronic health record and stored in a REDCap database. Using statistical software, the patient data were analyzed and stratified to assess the specific variables of the perioperative and postoperative course focusing on the high risk of hiatal hernia recurrence group (HRHR) and low risk hiatal hernia of recurrence group (LRHR). The HRHR group received a gastropexy and were defined using the following variables: comorbid state increasing abdominal pressure, gastric herniation > 30%, maximum transverse crural diameter > 4 cm, age 70 years or older, previous hiatal or abdominal wall hernia repair, BMI > 34, heavy weight bearing job/hobby, and/or emergent repair.

Results

Hiatal hernia repair with magnetic sphincter augmentation was performed on 137 patients. The HRHR group (N = 86) and the LRHR group (N = 51) were compared and there was a difference observed with acute hernia recurrence, dysphagia (p value = 0.008), and number of post-op EGDs (p value = 0.005) in favor of the HRHR group. Other postoperative variables observed (i.e., length of stay and PPI use) showed no significant difference between the two groups.

Conclusions

Fundic gastropexy for individuals who are considered high risk for recurrence does not appear to alter the perioperative course in our sample of patients. The HRHR group has the same length of stay experience and improved postoperative outcomes with reference to postoperative EGD, dysphagia and a decreasing trend in hiatal hernia recurrence.

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Authors and Affiliations

  1. Division of Thoracic and Foregut Surgery, Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA

    Robert Allman, James Speicher, Austin Rogers, Ethan Ledbetter, Aundrea Oliver, Mark Iannettoni & Carlos Anciano

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  1. Robert Allman
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  2. James Speicher
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  3. Austin Rogers
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  4. Ethan Ledbetter
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  5. Aundrea Oliver
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  6. Mark Iannettoni
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  7. Carlos Anciano
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Corresponding author

Correspondence to Carlos Anciano.

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Disclosures

Dr. Anciano has a relationship with Johnson & Johnson as a Clinical Consultant/Preceptor with duty of evaluation and supervision of initial placements of an anti-reflux device. Drs. Allman, Rogers, Dali, Iannettoni, Oliver, Speicher, and Mr. Ledbetter have no conflicts of interest or financial ties to disclose.

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Allman, R., Speicher, J., Rogers, A. et al. Fundic gastropexy for high risk of recurrence laparoscopic hiatal hernia repair and esophageal sphincter augmentation (LINX) improves outcomes without altering perioperative course. Surg Endosc 35, 3998–4002 (2021). https://doi.org/10.1007/s00464-020-07789-w

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  • DOI: https://doi.org/10.1007/s00464-020-07789-w

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