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Laparoscopic repair of type III/IV giant para-oesophageal herniae with biological prosthesis: a single centre experience

  • A. K. Shrestha
  • M. Joshi
  • L. DeBono
  • K. Naeem
  • S. BasuEmail author
Original Article
  • 30 Downloads

Abstract

Purpose

Repair of giant paraoesophageal herniae (GPEH) is technically challenging and requires significant experience in advanced foregut surgery. Controversy continues on suture versus mesh cruroplasty with the most recent systematic review and meta-analysis putting the onus on the operating surgeon. Study aim was to review whether the biological prosthesis (non-cross-linked bovine pericardium and porcine dermis) and the technique adopted for patients with GPEH had an influence on clinical and radiological recurrences.

Method

A retrospective analysis of a prospectively collected data of 60 consecutive patients with confirmed 5 cm hiatus hernia and ≥ 30% stomach displacement in the thorax that were operated in the upper gastrointestinal unit of a large district general hospital between September 2010 and August 2017. Pre and post-surgery Gastro-Oesophageal Reflux Disease Questionnaire [(GORD-HRQOL)] and a follow up contrast study were completed.

Results

60 included 2 (3%) and 58 (97%) emergency and elective procedures respectively with a male: female ratio of 1:3, age 71* (Median) (42–89) years, BMI 29* (19–42) and 26 (43%) with ASA III/IV. Investigations confirmed 46* (37–88) mm and 42* (34–77) mm transverse and antero-posterior hiatal defect respectively with 60* (30–100)% displacement of stomach into chest. Operative time and length of stay was 180* (120–510) minutes and 2* (1–30) days respectively. One (2%) converted for bleeding and 2 (3%) peri-operative deaths. Five (8%), 5 (8%) and 4 (7%) have dysphagia, symptomatic and radiological recurrences respectively. GORD-HRQOL recorded preoperatively was 27* (10–39) dropping significantly postoperatively to 0* (0–21) (P < 0.005) with 95% patient satisfaction at a follow up of 60* (36–84) months.

Conclusions

Our technique of laparoscopic GPEH repair with biological prosthesis is safe with a reduced symptomatic and radiological recurrence and an acceptable morbidity and mortality.

Keywords

Giant paraoesophageal herniae Cruroplasty Anti-reflux procedure Biological prosthesis GORD-HRQOL score 

Notes

Compliance with ethical standards

Conflict of interest

Authors would like to confirm here that there is no conflict of interest.

Ethical approval

The study received approval from the local institutional review board. The meshes used were approved for use in the United Kingdom.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Permission were obtained from patients for use in the article.

Supplementary material

Supplementary material 1 (MP4 448820 KB)

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • A. K. Shrestha
    • 1
  • M. Joshi
    • 1
  • L. DeBono
    • 2
  • K. Naeem
    • 3
  • S. Basu
    • 4
    • 5
    Email author
  1. 1.Department of General SurgeryEast Kent Hospitals University NHS Foundation Trust (EKHUFT)AshfordUK
  2. 2.Department of SurgeryOne Ashford HospitalWillesborough, AshfordUK
  3. 3.Department of RadiologyEKHUFTAshfordUK
  4. 4.Department of SurgeryEKHUFTAshfordUK
  5. 5.Department of SurgeryWilliam Harvey HospitalAshfordUK

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