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Efficacy of Laparoscopic Mesh-Augmented Hiatoplasty in GERD and Symptomatic Hiatal Hernia. Study Using Combined Impedance-pH Monitoring

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic fundoplication is the standard antireflux procedure. However, side effects such as gas bloating indicate that the procedure is not unproblematic. Laparoscopic mesh-augmented hiatoplasty (LMAH) might be an alternative operation aimed at restoring the intra-abdominal part of the esophagus and reducing the size of the diaphragmatic hiatus.

Aim

The aim of this study was to prospectively evaluate gastroesophageal reflux disease symptoms and gastroesophageal reflux before and after LMAH using 24 h impedance-pH monitoring (MII-pH).

Materials and Methods

Twenty patients underwent MII-pH monitoring pre- and 3 months post-LMAH. Symptoms were assessed using the Gastrointestinal Symptom Rating Scale questionnaire.

Results

LMAH reduced the mean (SD) reflux syndrome score [pre-op 4.5 (1.7) vs post-op 1.4 (0.9); p < 0.001], median (25th–75th percentile) distal %time pH < 4 [4.9 (3.4–10.3) vs 1.0 (0.3–2.5) %; p = 0.001) and total number of liquid reflux episodes [27.5 (17.5–38.3) vs 18 (7.3–29.3); p < 0.05] without changing the number of gas reflux episodes [12 (6–34.3) vs 13.5 (6–20); p = 0.346). All patients reported no limitation of their ability to belch.

Conclusion

LMAH significantly reduces reflux symptoms and esophageal acid exposure without interfering with the ability to vent gas from the stomach documented by an unchanged number of gas reflux episodes before and after LMAH.

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Authors and Affiliations

  1. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Georg R. Linke, Andreas Zerz, Francesco Marra & Rene Warschkow

  2. Division of Gastroenterology and Hepatology, University Hospital of Zurich, 8091, Zurich, Switzerland

    Radu Tutuian

  3. Department of General, Abdominal and Transplantation Surgery, University of Heidelberg, 69120, Heidelberg, Germany

    Beat P. Müller-Stich

  4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Jan Borovicka

Authors
  1. Georg R. Linke
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  2. Andreas Zerz
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  3. Radu Tutuian
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  4. Francesco Marra
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  5. Rene Warschkow
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  6. Beat P. Müller-Stich
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  7. Jan Borovicka
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Correspondence to Georg R. Linke.

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Linke, G.R., Zerz, A., Tutuian, R. et al. Efficacy of Laparoscopic Mesh-Augmented Hiatoplasty in GERD and Symptomatic Hiatal Hernia. Study Using Combined Impedance-pH Monitoring. J Gastrointest Surg 12, 816–821 (2008). https://doi.org/10.1007/s11605-008-0470-6

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  • DOI: https://doi.org/10.1007/s11605-008-0470-6

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