Laparoscopic repair of giant hiatus hernia: prosthesis is not required for successful outcome
Giant hiatus hernia (GHH) are difficult to manage effectively. This study reports a laparoscopic, prosthesis-free technique to repair of GHH.
Retrospective analysis of a prospectively populated database of a single surgeon’s experience of GHH (>30 % intrathoracic stomach) repair using a novel, uniform technique was performed. Routine postoperative endoscopy, quality of life (QOL), and Visick scoring was conducted.
Surgery was conducted in 100 patients (70F, 30 M). Mean (standard deviation [SD]) age was 69.1 (±11.4), median (interquartile range) ASA was 2 (range, 2–3), and mean (SD) body mass index (BMI) was 29.1 (±4.5). Mean follow-up was 574.1 (±240.5) days. One (1 %) patient was converted to an open procedure due to technical issues. Median stay was 2.5 days (range, 2–4). One postoperative death occurred secondary to respiratory sepsis. Eight (8 %) patients had perioperative complications: 4 major (PE, non-ST elevation MI, postoperative bleed managed conservatively, infected mediastinal fluid collection); and 4 minor (pneumothorax, asymptomatic troponin leak, subacute small bowel obstruction, and urinary retention). Ninety-nine (99 %) patients had objective screening for recurrence at 3–6 months. Two (2 %) patients have had symptomatic recurrence of their hiatus hernia; both involved a recurrent fundal herniation. Another seven (7 %) had small (<2 cm), asymptomatic recurrences diagnosed only on routine follow-up. Seven (7 %) patients have required reintervention for dysphagia with endoscopic dilatation conducted to good effect in all cases. Two (2 %) patients have required revisional surgery: one for a symptomatic recurrence at 3 months and a second for recurrent mediastinal collection. The Visick score fell from a mean (SD) of 3 (±1.1) to 1.7 (±0.8) postoperatively (p < 0.0001). The mean (SD) QOL preoperatively was 87.8 (±24) versus 109.1 (±22.3) postoperatively (p < 0.0001).
GHH can be managed safely and effectively laparoscopically, without the use of a prosthesis.
KeywordsGORD GERD (Gastro-oesophageal reflux disease) Giant hiatus hernia Laparoscopic fundoplication
Simon C. Gibson, Simon C. K. Wong, Alice Dixon, and Gregory L. Falk have no conflict of interest or financial ties to disclose.
- 6.Falk G, Falk S, Chan B (2012) Primary repair of giant hiatus hernia without mesh: early results of a method revisited. J Laparoendosc Adv Surg Tech (in press)Google Scholar
- 16.Nijjar R, Watson D, Jamieson G, Archer S, Bessell J, Booth M, Cade R, Cullingford G, Devitt P, Fletcher D, Hurley J, Kiroff G, Martin I, Nathanson L, Windsor J (2010) Five-year follow-up of a multicenter, double-blind randomized clinical trial of laparoscopic Nissen vs. anterior 90° partial fundoplication. Arch Surg 145:552–557PubMedCrossRefGoogle Scholar
- 19.Luketich J, Nason K, Christie N, Pennathur A, Jobe B, Landreneau R, MJ S (2010) Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 139:385–404Google Scholar
- 26.Oelschlager B, Pellegrini C, Hunter J, Brunt M, Soper N, Sheppard B, Polissar N, Neradilek M, Mitsumori L, Rohrmann C, Swanstrom L (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 213:416–418CrossRefGoogle Scholar
- 27.Oelschlager B, Pellegrini C, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244:481–490PubMedGoogle Scholar