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Hiatal hernia recurrences after laparoscopic surgery: exploring the optimal technique

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Abstract

Introduction

The recurrence rate of hiatal hernia (HH) after laparoscopic surgery with crural repair and Nissen or Toupet fundoplication is high (< 25–42%). HH repair can be reinforced with additional anterior sutures, vertical mesh strips (VMS) or mesh placement but the effect in the long-term (> 1 year) is still unclear. We determined the recurrence rate of HH after surgery and established whether the use of reinforcement techniques could reduce long-term recurrence rates.

Methods

In this retrospective cohort study patients were included if they underwent a laparoscopic fundoplication in this hospital between 2012 and 2019. HH was measured with computed tomography and baseline patient characteristics and surgical details were collected. Primary outcomes were recurrence of symptoms and re-intervention, secondary outcome was effect of surgical reinforcement techniques. Statistical analyses comprised chi-square tests, Mann–Whitney U tests and uni- and multivariable logistic regression analyses.

Results

In total, 307 patients were included, 206 women and 101 men. During primary surgery, 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of anterior sutures in 132 patients, VMS in 89 patients and mesh in 17 patients. After primary surgery, recurrence of HH was diagnostically confirmed in 64 patients (20.8%). Use of VMS during primary surgery was significantly associated with fewer recurrences (OR = 0.34, p = 0.048), corrected for confounding factors. Secondary surgery was performed in 54 patients (17.6%) and tertiary surgery in five patients (1.6%). Mesh and VMS were used more during secondary and tertiary surgery.

Conclusion

The recurrence rate among HH patients in this cohort study was 20.8% with a mean follow-up time of 6 years. Secondary surgery was performed in 17.6% of the patients. In future, the use of VMS might lead to fewer recurrences after primary laparoscopic repair of HH.

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Acknowledgements

We are grateful to all surgeons who performed the laparoscopic fundoplications in this research.

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Authors and Affiliations

  1. Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands

    B. Akmaz, A. Hameleers, E. G. Boerma, J. W. M. Greve, B. Meesters & J. H. M. B. Stoot

  2. Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands

    R. F. A. Vliegen

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  1. B. Akmaz
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  2. A. Hameleers
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  3. E. G. Boerma
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  4. R. F. A. Vliegen
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  5. J. W. M. Greve
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Correspondence to B. Akmaz.

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Disclosures

Drs Berdel Akmaz, Amber Hameleers, Dr Evert-Jan G Boerma, Dr Roy FA Vliegen, Prof Dr Jan Willem M Greve, Drs Berry Meesters and Dr Jan HMB Stoot have no conflicts of interest or financial ties to disclose.

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Akmaz, B., Hameleers, A., Boerma, E.G. et al. Hiatal hernia recurrences after laparoscopic surgery: exploring the optimal technique. Surg Endosc 37, 4431–4442 (2023). https://doi.org/10.1007/s00464-023-09907-w

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