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Laparoscopic anterior hemifundoplication and hiatoplasty for the treatment of upside-down stomach: mid- and long-term results after 40 patients

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Abstract

Background

Treatment of type 4 hiatal hernia using a minimally invasive approach is challenging and requires good familiarity with this technique.

Methods

From October 1992 to August 2010, 40 patients with a median age of 68 years underwent laparoscopic anterior hemifundoplication surgery for upside-down stomach and were included in our prospective study. The median symptoms duration was 5 years. The leading clinical symptoms were postprandial, epigastric, or retrosternal pain (80%), heartburn (78%), regurgitation (80%), dysphagia (53%), and anemia (48%). Preoperative evaluation included blood test, chest X-ray, upper endoscopy, and barium swallow. In some patients an esophageal 24-h pH study and esophageal manometry were performed. The median follow-up was 46 months using a standardized questionnaire, including Smiley score, modified Visick score, gastrointestinal quality-of-life index (GQLI), and specific reflux symptoms score.

Results

Surgery was finished laparoscopically in 39 patients (97%). One patient had to be converted to an open procedure because of severe adhesions. Mesh hiatoplasty had to be performed in one patient due to a large hiatal defect. Median operative time was 160 min (range = 90–275) and median blood loss was 5 ml (range = 0–300). Seven patients (18%) presented with acute symptoms. Intraoperative technical complications occurred in four patients (10%) and nontechnical complications in two cases (5%). Median postoperative hospital stay was 5 days (range = 2–17). Postoperative complications occurred in two patients (5%): one pleural effusion and one surgical emphysema. There was no mortality or symptomatic recurrence. All scores showed significant improvement and patient satisfaction.

Conclusion

Laparoscopic treatment of type 4 hiatal hernia is safe. With respect to the quality of life, anterior hemifundoplication is highly effective.

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Disclosures

Firas Obeidat, Reinhold A. Lang, Andreas Knauf, Michael N. Thomas, Tanija K. Hüttl, Nico P. Zügel, Karl-Walter Jauch, and Thomas P. Hüttl have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of Munich, Klinikum Großhadern, Marchioninistr. 15, 81366, Munich, Germany

    Firas W. Obeidat, Reinhold A. Lang, Andreas Knauf, Michael N. Thomas, Karl-Walter Jauch & Thomas P. Hüttl

  2. Department of Surgery, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Rue Emile Mayrisch, 4240, Esch-sur-Alzette, Luxemburg

    Nico P. Zügel

  3. Department of Paediatric Anaesthesiology, University Children’s Hospital Zürich, Steinwiesstr. 75, 8032, Zürich, Switzerland

    Tanija K. Hüttl

  4. Department of Surgery, Chirurgische Klinik München-Bogenhausen GmbH, Denninger Str. 44, 81679, München, Germany

    Thomas P. Hüttl

Authors
  1. Firas W. Obeidat
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  2. Reinhold A. Lang
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  3. Andreas Knauf
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  4. Michael N. Thomas
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  5. Tanija K. Hüttl
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  6. Nico P. Zügel
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  7. Karl-Walter Jauch
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  8. Thomas P. Hüttl
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Corresponding author

Correspondence to Reinhold A. Lang.

Additional information

F. W. Obeidat and R. A. Lang contributed equally to this work.

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Obeidat, F.W., Lang, R.A., Knauf, A. et al. 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 (2011). https://doi.org/10.1007/s00464-010-1537-5

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  • DOI: https://doi.org/10.1007/s00464-010-1537-5

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