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Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty

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Abstract

Background

Intrathoracic wrap migration is the most frequent morphological anatomic reason for failure of laparoscopic antireflux surgery (LARS). This study investigates whether the size of the esophageal hiatus is a factor in reherniation after LARS with mesh hiatoplasty and after primary failed hiatal closure.

Methods

Fifty-four patients who underwent a laparoscopic 270° Toupet fundoplication with simple sutured crura and posterior onlay of ParietexTM mesh prosthesis between October 2003 and June 2008 were evaluated with respect to the occurrence of postoperative intrathoracic wrap migration/reherniation. Indication for mesh hiatoplasty was a hiatus with a hiatal surface area (HSA) of at least 5.60 cm2 or slippage after the first LARS. The integrity of repair was assessed using a barium swallow test. Cinematography was performed at a median of 25.6 months (3–63 months after operation) and was completed in 49 of 54 patients (90%). Follow-up was completed in 24 patients who underwent primary LARS (group A) and 25 patients who underwent a laparoscopic refundoplication (group B).

Results

In group A, the occurrence of postoperative wrap reherniation was diagnosed in 20.8% of the patients, compared to 40% in group B. In both groups only one patient with recurrent hiatal hernia was symptomatic. In group A, patients who developed a recurrent hernia had a larger HSA than patients without postoperative reherniation. There was a huge difference in the size of the HSA between symptomatic and asymptomatic patients with reherniation. In comparison, group B patients had HSA of similar size in all described cases.

Conclusion

In primary intervention, recurrence of hiatal hernia is more likely the larger the HSA is. The size of the hiatus is a major contributing factor to the possibility of reherniation. After failed primary hiatal closure, the size of the hiatal defect is no marker for the possibility of reherniation.

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Disclosures

Oliver Owen Koch, Kai Uwe Asche, Johannes Berger, Eva Weber, Frank Alexander Granderath, and Rudolph Pointner have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General Surgery, General Hospital Zell am See, Paracelsusstraße 8, 5700, Zell am See, Austria

    Oliver O. Koch, Kai U. Asche, Eva Weber & Rudolph Pointner

  2. Division of Clinical Psychology, General Hospital Zell am See, 5700, Zell am See, Austria

    Johannes Berger

  3. Department of General and Visceral Surgery, Neuwerk Hospital, Mönchengladbach, Germany

    Frank A. Granderath

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  1. Oliver O. Koch
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  2. Kai U. Asche
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Correspondence to Oliver O. Koch.

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Koch, O.O., Asche, K.U., Berger, J. et al. Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg Endosc 25, 1024–1030 (2011). https://doi.org/10.1007/s00464-010-1308-3

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