Skip to main content
SpringerLink
Log in

Erfahrungen aus 12 Jahren chirurgischer Versorgung von 286 paraösophagealen Hernien

Report of 12 years experience in the surgical treatment of 286 paraesophageal hernias

  • Originalien
  • Published:
Der Chirurg Aims and scope Submit manuscript

An Erratum to this article was published on 03 June 2016

Zusammenfassung

Einleitung

Im Gegensatz zu axialen Hiatushernien sind paraösophageale Hernien selten und können zu chronischer Eisenmangelanämie und schweren akuten Komplikationen führen. Die Versorgung ist vielfältig und einheitliche Standards fehlen.

Ziel

Ziel der Arbeit war es, unsere Erfahrungen an 286 Patienten mit paraösophagealen Hernien, die von 2003 bis 2014 im Klinikum Augsburg operiert wurden, insbesondere im Hinblick auf Morbidität, Letalität, Lebensqualität und Rezidivrate zu schildern.

Material und Methoden

In 12 Jahren wurden insgesamt 286 paraösophageale Hernien operiert, davon 255 Eingriffe elektiv laparoskopisch und 31 offen als Notfalleingriffe. Die obligate hintere Hiatoplastik wurde bei 138 Patienten (48 %) mit einem leichtgewichtigen Kunststoffnetz verstärkt, welches in 90 Fällen mit Fibrinkleber fixiert wurde. Die intraabdominelle Fixierung des Magens bestand neben einer Gastropexie in einer ventralen (n = 244) oder dorsalen (n = 42) Fundoplikation.

Ergebnisse

Komplikationen traten bei 8,4 % der Patienten auf. Die mittlere Liegedauer der Elektiveingriffe betrug 5,3 (± 2,8) Tage, die der Notfalleingriffe 24,7 (± 17,8) Tage. Der gastrointestinale Lebensqualitätsindex nach Eypasch stieg von präoperativ 92,8 (± 22,5) signifikant auf 109,6 (± 20,2) im postoperativen Verlauf an (p < 0,001). 20 Patienten (7 %) erlitten operationspflichtige Rezidive, davon 7 Früh- und 13 Spätrezidive. Während unmittelbar postoperativ radiologisch festgestellte Frührezidive umgehend revidiert wurden, richtete sich die Strategie der Spärtrezidive im Langzeitverlauf nach der Klinik: asymptomatische Hernien wurden konservativ, symptomatische Hernien operativ behandelt. Symptomatische Spätrezidive entwickelten 4,6 % unserer Patienten, wobei dies 7,4 % (11/148) der Patienten ohne und 1,4 % (2/138) mit primärer Netzversorgung betraf.

Schlussfolgerung

An 286 Patienten konnte gezeigt werden, dass paraösophageale Hernien mit geringer Morbidität und Letalität versorgt werden können und das operative Ergebnis zu großer Patientenzufriedenheit führt. Netzimplantationen reduzierten die Rezidivrate. Die Erfassung der Lebensqualität ist ein gut geeigneter klinischer Verlaufsparameter bei der Beurteilung paraösophagealer Hernien.

Abstract

Background

In contrast to axial hiatus hernias, paraesophageal hernias are rare but can lead to chronic iron deficiency anemia and severe acute complications. Treatment is manifold and consistent standards are lacking.

Objectives

The aim of this study was to describe our experiences of 286 patients with paraesophageal hernias, who underwent surgery from 2003 to 2014 at a tertiary referral center. The study was particularly concerned with morbidity, mortality, quality of life and recurrence rates.

Material and methods

In 12 years a total of 286 paraesophageal hernias were surgically treated, 255 with a minimally invasive procedure and 31 with an open approach. In 138 patients (48 %) the suture-based hiatoplasty was reinforced by means of a lightweight mesh, which was fixed with fibrin glue in 90 cases. Abdominal fixation of the stomach consisted of a gastropexy and anterior (n = 244) or posterior (n = 42) fundoplication.

Results

Complications arose in 8.4 % of the patients. The mean hospital stay was 5.3 (± 2.8) days for elective surgery and 24.7 (± 17.8) days for emergency operations. The gastrointestinal quality of life index according to Eypasch significantly increased from mean preoperative values of 92.8 (± 22.5) to 109.6 (± 20.2) in the postoperative course (p < 0.001). Of the patients 20 (7 %) suffered a recurrence requiring surgery, including 7 early and 13 late recurrences. During the immediate postoperative period radiographically detected recurrences were promptly revised. The strategy of late recurrences in the long-term course was based on patient symptoms and asymptomatic hernias were treated conservatively while symptomatic hernias were surgically treated. Symptomatic late recurrences developed in 4.6 % of the patients, including 7.4 % (11 out of 148) without and 1.4 % (2 out of 138) with primary mesh repair.

Conclusion

The repair of paraesophageal hernias in 286 patients provided excellent patient satisfaction and symptom improvement with low perioperative morbidity and mortality. Mesh reinforcement reduced the recurrence rate. The quality of life index is a suitable clinical course parameter for evaluation of paraesophageal hernias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Andujar JJ, Papasavas PK, Birdas T et al (2004) Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation. Surg Endosc 18:444–447

    Article  CAS  PubMed  Google Scholar 

  2. Daigle CR, Funch-Jensen P, Calatayud D et al (2014) Laparoscopic repair of paraesophageal hernia with anterior gastropexy: a multicenter study. Surg Endosc 29(7):1856–1861

    Article  PubMed  Google Scholar 

  3. Diaz S, Brunt LM, Klingensmith ME et al (2003) Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 7:59–66. (discussion 66–57)

    Article  PubMed  Google Scholar 

  4. Edye MB, Canin-Endres J, Gattorno F et al (1998) Durability of laparoscopic repair of paraesophageal hernia. Ann Surg 228:528–535

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Eypasch E, Wood-Dauphinee S, Williams JI et al (1993) [The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery]. Chirurg 64:264–274

    CAS  PubMed  Google Scholar 

  6. Fortelny RH, Petter-Puchner AH, Glaser KS (2009) Fibrin sealant (Tissucol) for the fixation of hiatal mesh in the repair of giant paraesophageal hernia: a case report. Surg Laparosc Endosc Percutan Tech 19:e91–94

    Article  PubMed  Google Scholar 

  7. Fortelny RH, Petter-Puchner AH, Glaser KS et al (2010) Fibrin sealant (Tisseel) for hiatal mesh fixation in an experimental model in pigs. J Surg Res 162:68–74

    Article  CAS  PubMed  Google Scholar 

  8. Frantzides CT, Madan AK, Carlson MA et al (2002) A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137:649–652

    Article  PubMed  Google Scholar 

  9. Furnee EJ, Draaisma WA, Gooszen HG et al (2011) Tailored or routine addition of an antireflux fundoplication in laparoscopic large hiatal hernia repair: a comparative cohort study. World J Surg 35:78–84

    Article  PubMed  PubMed Central  Google Scholar 

  10. Geissler B, Probst A, Anthuber M (2010) Chirurgische Therapie der paraösophagealen Hernien. Aktuelle Übersicht und eigene Erfahrungen an 103 konsekutiven Patienten. Chirurgische Praxis 72:239–248

    Google Scholar 

  11. Granderath FA, Granderath UM, Pointner R (2008) Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results. World J Surg 32:999–1007

    Article  CAS  PubMed  Google Scholar 

  12. Greene CL, Demeester SR, Zehetner J et al (2013) Diaphragmatic relaxing incisions during laparoscopic paraesophageal hernia repair. Surg Endosc 27:4532–4538

    Article  PubMed  Google Scholar 

  13. Hashemi M, Peters JH, Demeester TR et al (2000) Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 190:553–560. (discussion 560–551)

    Article  CAS  PubMed  Google Scholar 

  14. Horvath KD, Swanstrom LL, Jobe BA (2000) The short esophagus: pathophysiology, incidence, presentation, and treatment in the era of laparoscopic antireflux surgery. Ann Surg 232:630–640

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Johnson JM, Carbonell AM, Carmody BJ et al (2006) Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications: a critical analysis of the available literature. Surg Endosc 20:362–366

    Article  CAS  PubMed  Google Scholar 

  16. Kemppainen E, Kiviluoto T (2000) Fatal cardiac tamponade after emergency tension-free repair of a large paraesophageal hernia. Surg Endosc 14:593

    CAS  PubMed  Google Scholar 

  17. Koetje JH, Irvine T, Thompson SK et al (2015) Quality of Life Following Repair of Large Hiatal Hernia is Improved but not Influenced by Use of Mesh: results from a randomized controlled trial. World J Surg. 2015Jun; 39(6):1465–1473

  18. Kohn GP, Price RR, Demeester SR et al (2013) Guidelines for the management of hiatal hernia. Surg Endosc 27:4409–4428

    Article  PubMed  Google Scholar 

  19. Koop H, Fuchs KH, Labenz J et al (2014) [S2 k guideline: gastroesophageal reflux disease guided by the German Society of Gastroenterology: AWMF register no. 021–013]. Z Gastroenterol 52:1299–1346

    Article  PubMed  Google Scholar 

  20. Latzko M, Borao F, Squillaro A et al (2014) Laparoscopic repair of paraesophageal hernias. JSLS 18(3) doi:10.4293/JSLS.2014.00009

  21. Legner A, Tsuboi K, Bathla L et al (2011) Reoperative antireflux surgery for dysphagia. Surg Endosc 25:1160–1167

    Article  PubMed  Google Scholar 

  22. Luketich JD, Nason KS, Christie NA et al (2010) Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 139:395–404, 404 e391

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lukovich P, Dudas I, Tari K et al (2013) PEG fixation of an upside-down stomach using a flexible endoscope: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 23:e65–69

    Article  PubMed  Google Scholar 

  24. Mattioli S, Lugaresi ML, Costantini M et al (2008) The short esophagus: intraoperative assessment of esophageal length. J Thorac Cardiovasc Surg 136:834–841

    Article  PubMed  Google Scholar 

  25. Mehta S, Boddy A, Rhodes M (2006) Review of outcome after laparoscopic paraesophageal hiatal hernia repair. Surg Laparosc Endosc Percutan Tech 16:301–306

    Article  PubMed  Google Scholar 

  26. Morris-Stiff G, Hassn A (2008) Laparoscopic paraoesophageal hernia repair: fundoplication is not usually indicated. Hernia 12:299–302

    Article  CAS  PubMed  Google Scholar 

  27. Muller-Stich BP, Linke G, Leemann B et al (2006) Cardiac tamponade as a life-threatening complication in antireflux surgery. Am J Surg 191:139–141

    Article  PubMed  Google Scholar 

  28. O’rourke RW, Khajanchee YS, Urbach DR et al (2003) Extended transmediastinal dissection: an alternative to gastroplasty for short esophagus. Arch Surg 138:735–740

    Article  Google Scholar 

  29. Obeidat FW, Lang RA, Knauf A et al (2011) Laparoscopic anterior hemifundoplication and hiatoplasty for the treatment of upside-down stomach: mid- and long-term results after 40 patients. Surg Endosc 25:2230–2235

    Article  PubMed  Google Scholar 

  30. Oelschlager BK, Pellegrini CA, Hunter J et al (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244:481–490

    PubMed  PubMed Central  Google Scholar 

  31. Oelschlager BK, Pellegrini CA, Hunter JG et al (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 213:461–468

    Article  PubMed  Google Scholar 

  32. Oelschlager BK, Yamamoto K, Woltman T et al (2008) Vagotomy during hiatal hernia repair: a benign esophageal lengthening procedure. J Gastrointest Surg 12:1155–1162

    Article  PubMed  Google Scholar 

  33. Rathore MA, Andrabi SI, Bhatti MI et al (2007) Metaanalysis of recurrence after laparoscopic repair of paraesophageal hernia. JSLS 11:456–460

    PubMed  PubMed Central  Google Scholar 

  34. Stadlhuber RJ, Sherif AE, Mittal SK et al (2009) Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 23:1219–1226

    Article  PubMed  Google Scholar 

  35. Stein HJ, Rahden BH, Feussner H (2011) Hiatushernien und andere Erkrankungen des Zwerchfells. In: Siewert JR, Rothmund M, Schumpelick V (Hrsg) Praxis der Viszeralchirurgie. Gastroenterologische Chirurgie, 3. Aufl. Springer, S 349–362 ISBN: 978-3-642-14222-2

    Chapter  Google Scholar 

  36. Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236:492–500. (discussion 500–491)

    Article  PubMed  PubMed Central  Google Scholar 

  37. Targarona EM, Novell J, Vela S et al (2004) Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia. Surg Endosc 18:1045–1050

    Article  CAS  PubMed  Google Scholar 

  38. Tatum RP, Shalhub S, Oelschlager BK et al (2008) Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg 12:953–957

    Article  PubMed  Google Scholar 

  39. White BC, Jeansonne LO, Morgenthal CB et al (2008) Do recurrences after paraesophageal hernia repair matter?: ten-year follow-up after laparoscopic repair. Surg Endosc 22:1107–1111

    Article  CAS  PubMed  Google Scholar 

  40. Williamson WA, Ellis FH Jr, Streitz JM Jr et al (1993) Paraesophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 56:447–451. (discussion 451–442)

    Article  CAS  PubMed  Google Scholar 

  41. Yano F, Stadlhuber RJ, Tsuboi K et al (2009) Preoperative predictability of the short esophagus: endoscopic criteria. Surg Endosc 23:1308–1312

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland

    B. Geißler,  E. Birk &  M. Anthuber

Authors
  1. B. Geißler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Birk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Anthuber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Geißler.

Ethics declarations

Interessenkonflikt

B. Geissler, E. Birk und M. Anthuber geben an, dass kein Interessenkonflikt besteht

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Geißler, B., Birk, E. & Anthuber, M. Erfahrungen aus 12 Jahren chirurgischer Versorgung von 286 paraösophagealen Hernien. Chirurg 87, 233–240 (2016). https://doi.org/10.1007/s00104-015-0066-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-015-0066-0

Schlüsselwörter

Keywords

Search

Navigation